• Medication Usage Authorization Form for Overnight Retreats/Events

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  • This form must be submitted before or on the day of departure for each ECC Student event.

  • Will the student be requiring any medications (prescription OR over the counter) while on this overnight event?*

  • Please send ALL medications (prescription and/or over the counter medication) with your child that they will need to take while at the ECC Student event/retreat

  • My child will be responsible for the management of their own medication*
  • Dates Medicine to Be Taken*
  • Dates Med. to Be Taken
  • Dates Med. to Be Taken
  • Dates Med. to Be Taken
  • Parental/Guardian Signature*
  • Date*
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  • Should be Empty: