Student Handbook



Download 0.5 Mb.
Page16/17
Date01.06.2018
Size0.5 Mb.
#52538
1   ...   9   10   11   12   13   14   15   16   17

Medical Form

Students Name : _____________________________________________

Last Name, First Name
PERMISSION TO ADMINISTER MEDICATION AT RTCA

My child(ren) may be given Tylenol, Advil, Motrin, Pepto-Bismol or cough drops by the school administrator. I understand that any other medications must be kept in the administration office and will require a note and dosage instructions signed by the parent.



Parent's Signature: _____________________________ Date: _
Please list any illnesses, allergies, or other physical problems each child has:



Please list any medications each child takes on a daily basis:










AUTHORIZATION FOR MEDICAL TREATMENT

As the parent(s)or legal guardian of the student(s) listed above, I/we hereby grant to the Headmaster (or whomever he/she may designate) of Robert Toombs Christian Academy, the authority to sign authorization for medical treatment of the above named student(s). This authority is granted only under the following three (3) conditions: (1) the injury was incurred during school hours, (2) the injury was incurred while participating in athletic games representing Robert Toombs Christian Academy , (3) the parent or legal guardian is not available to sign authorization at the time of injury. Authorization covers any emergency treatment prescribed by the licensed physician assessing the injury (including admission as inpatient).


Signature of Custodial Parent: _______________________ Date: ____





Directory: wp-content -> uploads -> 2017
2017 -> Leadership ohio
2017 -> Ascension Lutheran Church Counter’s Schedule January to December 2017
2017 -> Board of directors juanita Gibbons-Delaney, mha, rn president 390 Stone Castle Pass Atlanta, ga 30331
2017 -> Military History Anniversaries 16 thru 31 January Events in History over the next 15 day period that had U. S. military involvement or impacted in some way on U. S military operations or American interests
2017 -> The Or Shalom Cemetery Community Teaching on related issues of Integral
2017 -> Ford onthult samenwerking met Amazon Alexa en introduceert nieuwe navigatiemogelijkheden van Ford sync® 3 met Applink
2017 -> Start Learn and Increase gk. Question (1) Name the term used for talking on internet with the help of text messege?
2017 -> Press release from 24. 03. 2017 From a Charleston Car to a Mafia Sedan
2017 -> Tage Participants
2017 -> Citi Chicago Debate Championship Varsity and jv previews

Download 0.5 Mb.

Share with your friends:
1   ...   9   10   11   12   13   14   15   16   17




The database is protected by copyright ©ininet.org 2024
send message

    Main page