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Permission to Dispense Medication Waiver and Release of All 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the NAME OF PROGRAM(S) and DATE at the top of the form. This helps identify the specific program for which medication is being dispensed.
- In the section labeled 'I, ___________,' fill in your name as the parent or guardian, followed by your child's name in the designated space.
- List all medications you authorize staff to administer under 'the following medications.' Ensure that you provide clear names of each medication.
- Complete the allergy and medical history sections, including any allergies and relevant medical conditions like asthma. This information is crucial for safety.
- Sign and date at the bottom of the form to confirm your authorization. Make sure all fields are filled accurately before submitting.
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Related links
I give permission for WPI program staff to provide routine healthcare, first-aid, administer prescribed and over the counter medications as described andRead more
This form must be completed by the physician and the parent/guardian and contain their signatures before any medication can be administered at or by the City