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

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

Marie Philip School Walden School
Student Name: *

First Name Last 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 Name Last Name
Should be Empty: