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"Over the Counter" Authorization Form
Please check the items that you give permission for your child to receive:
*
Arnica Cream (for bumps & bruises) - [contains peanut oil]
Arnica Gel (for bumps & bruises)
Calendula Ointment (for rashes & minor skin irritations) - [contains peanut oil]
Burn-Care (for burns & sunburn)
Sting Stop Gel (for insect bites & stings)
Rescue Remedy (taken orally for emotional distress due to minor accidents/injuries)
Eye-wash (saline solution) (to remove dirt or other particles from the eye)
Caladryl lotion (itch reliever)
Sunscreen
Some of the above products contain peanut oil and are identified as such. These remedies bear a label notating “contains peanut oil”.
Agreement
*
By checking here and filling the name and the date below, I certify that I have provided the above information.
*
Indicates required field
Parent/guardian name
*
First
Last
Date
*
Please Note: We do not keep any Over the Counter medication in the Front Office. If your child has reason to need Benadryl, Claritin, Advil, Etc. please complete the medication authorization form and provide the front office with the over the counter medication.
Parents must pick up medication of any kind. Medicine will not be given to children to take home. Turn this form in to the Front Office Coordinator.
Submit
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