Other Medical Treatment. In the event it comes to the attention of Saint Xxxxxx Xxxxx & Seminary College or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called collect (with phone charges reversed to myself). Signature: Date:
Other Medical Treatment. In the event it comes to the attention of DESIGNATED SPERVISOR or staff that SON/DAUGHTER becomes ill with symptoms of headache, vomiting, sore throat, fever, or diarrhea, I DO want to be called collect (with phone charges reversed to myself in necessary). Signature: Date:
Other Medical Treatment. In the event it comes to the attention of the program directors or volunteers that my child becomes ill (headache, vomiting, sore throat, fever, diarrhea), I want to be called immediately. Signature Date:
Other Medical Treatment. In the event it comes to the attention of DESIGNATED SUPERVISOR or staff that my SON/DAUGHTER/XXXX becomes ill with symptoms of headache, vomiting, sore throat, fever, or diarrhea, I DO want to be called collect (with phone charges reversed to myself if necessary). Signature Date Medications: SON/DAUGHTER/XXXX is taking medications at present and will bring all such medications necessary, and such medications will be well-labeled. I give permission for SON/DAUGHTER/XXXX to take this medication on his/her own. The dosage and frequency of dosage is as follows: Signature Date If requested, I DO give permission for SON/DAUGHTER/XXXX to be given the following (circle): Aspirin Benedryl Midol Ibuprofen Pepto Bismo Cough drops Aspicream Tums Sudafed Primatene Mist Tylenol Other Signature Date
Other Medical Treatment. In the event it comes to the attention of the parish, its officers, directors and agents, and the Archdiocese of Washington, chaperones, or representatives associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called collect (with phone charges reversed to myself). Signature: Date: Medications: My child is taking medication at present. My child will bring all such medications necessary, and such medications will be well labeled. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency of dosage, are as follows: Signature: Date: _ No medication of any type, whether prescription or non-prescription, may be administered to my child unless the situation is life threatening and emergency treatment is required. Signature: Date: I hereby grant permission for non-prescription medication (such as non-aspirin products, i.e. acetaminophen or ibuprofen, throat lozenges, cough syrup) to be given to my child, if deemed appropriate. Signature: Date:
Other Medical Treatment. In the event it comes to the attention of the School, its officers, directors, employees, agents, volunteers, and representatives associated with the event, or the Diocese of Reno, its employees, agents and volunteers, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I want to be called.
