Permission to administer medication form
Elite Development Coaching will not give your child medicine unless you complete and sign this form. The form needs to be completed for each new session/holiday camp.
Child's Name
*
First Name
Last Name
Medical Condition/Illness
*
Training Session
*
Date/s
*
Medicine
*
Dosage & Method
*
Timing
*
Are there any known side effects?
*
Can your child self administer?
*
Yes
No
Any other information you wish to add
Procedure to take in an emergency
*
Parent's Name
*
First Name
Last Name
Contact Number
*
Parent's Email :
*
example@example.com
Please tick the following:
*
By signing this form, I herby give permission for Elite Development Coaching to administer an medication, medicine or EPI pen to my child.
Although I understand they may not be fully qualified to do so and accept full responsibility.
I can confirm the Medication/EPI pen is clearly labelled with my child's name.
I can confirm I have given all relevant information regarding my child.
Signed:
*
Date
*
-
Day
-
Month
Year
Date
Submit
Should be Empty: