• CHS Marching Band Medication Authorization (2022-2023)

    (please complete this entire form)

  • Medication can only be administered with written permission from legal parent/guardian. Medications include: prescriptions, over-the-counter medications, homeopathic remedies, and supplements (e.g., vitamins, Tylenol, Benadryl, inhalers, etc.)

    All medication, including over-the-counter meds, should be given to the person overseeing first aid (coach, nurse, band director or first-aid volunteer) upon arrival at camp, practice or games.

    For the safety of all of our students and staff, we do not allow students to keep possession of any medication during school events (except for inhalers and EPI pens

    Prescription medications MUST be in the original bottle/packaging that identifies the prescribing physician, name of medication, dosage, and frequency of medication.

    Students should know what their medication is, be able to recognize it, know the dosage, and when they should take it. (This is always good practice!)

  • Birth Date
     / /
    2 digit month, 2 digit day, 4 digit year

  • Please select YES or NO for each of the following over-the-counter medications that you will allow your student to be given during camp, practices or games, upon their request. Medications will be administered as directed on the packaging at the discretion of the band director, nurse, first aid volunteer and/or chaperone.

  • Acetaminophen (Tylenol) for pain relief, swelling*
  • Ibuprofen (Advil, Motrin) or Naproxen (Aleve) for pain relief, swelling*
  • Phenylephrine decongestant (Sudafed PE) for congestion*
  • Cough Syrup (Robitussin) for cough*
  • Diphenhydramine antihistamine (Benadryl) for swelling, hives, allergic reaction*
  • Cetirizine (Zyrtec) or loratadine (Claritin) for environmental allergies*
  • Throat lozenges or spray for sore throat*
  • Bismuth subsalicylate (Pepto-Bismol) for diarrhea or upset stomach*
  • Loperamide (Immodium A-D) for diarrhea*
  • Laxatives (Milk of Magnesia, Ex-Lax) for constipation or upset stomach*
  • Calamine lotion for bug bites, hives or poison ivy*
  • Antibiotic cream/ointment for minor wound care*
  • Hydrocortisone 1% cream for mild skin irritations, poison ivy, or insect bites*
  • Aloe (for sunburn)*
  • Anti-fungal cream (Micatin) for athlete's foot*
  • Eye drops for minor eye irritation*
  • Prescription or Routine Medications*

  • Complete this section only if routine meds will be given or might be needed during camp, practice or games.

  • How it is given
  • How it is given
  • How it is given

  • Final Section

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  •  
  • Should be Empty: