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Permission to Dispense Medication Waiver and Release of All

Permission to Dispense Medication Waiver and Release of All 2026

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The document outlines the procedures and requirements for the Northern Suburban Special Recreation Association to dispense medication to participants. It includes a waiver and release of claims that parents or guardians must sign, granting permission for staff to administer specified medications to their child. The document emphasizes the responsibility of parents to provide medications, details on potential adverse reactions, and instructions for emergency situations related to allergic reactions. Additionally, it contains sections for medication information, dosage, and emergency contacts.

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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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