Request for Administration of Medication During Scout

                     Troop 449 Camping Trips

Educating our scout’s to reach their full potential in scouting

Parents or guardians of scouts requesting that medication be administered during

Camping trips by troop leaders are required to provide to the troop parent or guardian

Authorization and medication in a container appropriately labeled by a pharmacist

Only when medication is prescribed to be taken during camping trips will a child be

Given medication at camp

Scout’s Name _________________________________

Parent’s request for Administration of medication by scout

Personnel during scout camping trips

Medication __________________________________ Dose ______________

Time ______________

For treatment of __________________________________________________________

Possible side effects_______________________________________________________ _______________________________________________________________________

Special instructions _______________________________________________________

________________________________________________________________________

Last time to be given ____________

I request this medication be given as prescribed. If necessary,

 
Parent/Guardian Signature ________________________________

Day time phone __________________ Date ________________