Residential Students Over the Counter (OTC) Medication Permission: 2020-2021

Residential Students Over the Counter (OTC) Medication Permission: 2020-2021
Please Choose:*

Marie Philip SchoolWalden School
Student Name:*

First NameLast Name
The following over the counter medications will be given to your child if the need arises, with both parent/guardian permission and an MD’s order.

I give permission for my child to receive the medications listed below during the school year. I have checked NO for any medications or creams that I do NOT give permission for my child to receive.
Tylenol*
Robitusson*
Bacitracin Ointment*
Tums*
Sunblock*
Advil*
Cough Drops*
Muscle Rub (i.e. Bengay)
Hydrocortisone Cream
Please indicate any other OTC medications your child may need:
Signature

Clear
Parent/Guardian Name:*

First NameLast Name
Should be Empty: