2024 Summer Tri-Wing CAPF 163 - Over the Counter Medication

Permission for Provision of Minor Cadet Over-The-Counter Medication
Cadet Name (Last, First, Middle)*
CAP Grade*
CAP ID*
Charter Number*
i.e. MAR-MD-001
Over-The Counter/Non-Prescription Medications
The following over-the counter medications may be administered according to package directions by CAP senior members. Cross out any medications not approved.
- Acetaminophen (Tylenol) for fever or pain
- Ibuprofen (Advil, Motrin) for fever or pain
- Bacitracin or Neosporin antibiotic ointment to prevent infection
- Hydrocortisone anti-inflammatory rash cream
- Calamine/Caladryl for poison ivy itch relief
- Antifungal creams and sprays for treatment of fungal rashes
- Visine eye drops for dry, irritated eye relief
- Op-Con A eye drops for allergic conjunctivitis
- Benadryl liquid/tabs for allergic reactions
- Claritin antihistamine for seasonal allergies
- Robitussin products for relief of cough and cold symptoms
- Tums or Maalox for relief of stomach upset
- Delsym to suppress cough
Are All the over-the-counter medications listed above approved?*

YesNo, Please complete the box below.
Type a question
Which over-the-counter medications listed above are NOT approved?
Are there additional over the counter medications, not listed above, that you would like to approve?*

NoYes, Please complete the box below.
Type a question
Which additional over the counter medications do you approve?
Allergies
My child/ward has the following allergies or reactions to over the counter medications (list type of reaction) (type "N/A" if none):*
Consent For Minor Cadet To Receive Over-The-Counter Medications

My signature below evidences my consent for CAP senior members to provide over-the-counter non-prescription medications (such as those listed above) to my child/ward if indicated in the reasonable judgment of such senior members. I understand that I will be informed if any such medications are administered.
Signature Date

MonthDayYear
Signature of Parent/Guardian*

Clear
Should be Empty:

Permission for Provision of Minor Cadet Over-The-Counter Medication

Over-The Counter/Non-Prescription Medications

Allergies

Consent For Minor Cadet To Receive Over-The-Counter Medications