CONSENT FOR MEDICATION ADMINISTRATION. To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under the age of 18 while at Xxxx Xxxxxxxx Basketball Camps, LLC, it is camp policy to secure your consent for medication distribution and for the use of medical devices. The medication or medical device can be administered by the Camp Health Supervisor. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. You must also complete the form below. ❑ No medicationhas been brought to camp. ❑ I wantthemedication or medicaldevicesself-administered (age14 andaboveonly). ❑ I wantthemedication or medicaldeviceadministered bythe Camp Sports Medicine Staff. ❑ However,alimitedamountofmedicationforlifethreateningconditionsmaybecarriedbymyson/daughter/xxxx(e.g., beestingkits,inhalers). Name of Medication(s): Amount of Dosage to be Taken: How is Medication Taken? Time(s) of Day to be Taken: Name of Prescribing Doctor: Doctor’s Phone Number: Special Instructions: Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date CONSENT FOR MEDICAL TREATMENT: To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under 18 while at our camp, it is our policy to secure your consent for medical treatment. By signing below you are giving your consent in advance for medical treatment at an appropriate medical facility in case of illness or injury. By signing below you are stating that you are aware of and accept the risk inherent in the program activity. Signature of participant (if 18 or older) Date Signature of Parent or Guardian (if Participant is under 18 years old) Date
CONSENT FOR MEDICATION ADMINISTRATION. To the Parent(s) or Legal Guardian(s): If your son, daughter or xxxx will be under the age of 18 while at the University of Wisconsin-Milwaukee, it is camp policy to secure your consent for medication distribution and for the use of medical devices. The medication or medical device can be administered by the Camp Health Supervisor. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. You must also complete the form below. q No medication has been brought to camp. q I want the medication or medical devices self-administered (age 14 and above only).
