Medication Permission Slip - Castle Rock Ranch Camp

Please complete and sign this permission slip if your child will be requiring medication, prescription or over the counter, while at Castle Rock Ranch Camp. All medications should be in the original pharmacy container with the label intact. Each should include your child’s full name, name of medication, and proper dosage.

Thank you for your cooperation.

Y o u h a v e m y p e r m i s s i o n t o g i v e my child h e r / h i s m e d i c a t i o n w h i l e a t t h e Castle Rock Ranch Camp .

Child's Name

First Last

1. Medication Name

Reason for giving medication

Dosage

Time to be given

2. Medication Name

Reason for giving medication

Dosage

Time to be given

Dosage

3. Medication Name

Reason for giving medication

Time to be given

Signature of Parent/Guardian

Date Signed