Medical Release & OTC Medication Consent
Complete your details and authorize staff to administer basic over-the-counter medications if needed during the winter retreat.
Child's Full Name
*
First Name
Last Name
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I give permission for the staff to provide ibuprofen, Pepto Bismol, or other basic over-the-counter medications to my child if needed while at winter retreat.
*
Yes, I give permission
No, I do not give permission
Please list any allergies or medications your child is currently taking.
Parent/Guardian Signature
*
Submit Consent
Submit Consent
Should be Empty: