Medcation Waiver
MEDICATION WAIVER
This waiver allows the following_________________________________________ to supply ____________________________________ with his/her prescribed/non-prescribed medication as per directions on bottle. All medication will be in its original container and as for prescribed medication the person’s name and medical professionals’ information must be on the container.
By signing this waiver you are releasing the above from any and all liability in relation to the handling of the medication.
Medication Directions
__________________ _____________________________________________________
__________________ _____________________________________________________
__________________ _____________________________________________________
__________________ _____________________________________________________
__________________ _____________________________________________________
By signing this document you understand and agree to the above. If you do not agree with any of the above you must attend the campout in order
for your son to receive his medication or he will not attend the campout.
Dates of trip _____________________________________________
Adult/Parent/Guardian (print) ____________________________________________
Parent/Guardian _____________________________________________
Date _____________________________________________