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                                                                 Medication Permission Slip



I,  ___________________________, parent of  ________________________________ do hereby give my permission for Rosebud
Preschool Staff give the following medicines to my child.   
 
_____________________                         _____________________                        ____________________________________
 Name of Medicine                                     Dose to be Given                                      Time/s to be given


_____________________                        ______________________                      _____________________________________            
Name of  Medicine                                    Dose to be Given                                      Time/s to be given


_____________________                        _______________________                    _____________________________________
Name of Medicine                                     Dose to be Given                                      Time/s to be given


_____________________                        _______________________                     _____________________________________
Name of Medicine                                     Dose to be given                                        Time to be given 


 
 _____________________________________________
Name of Parent or Guardian
 
_____________________________
Date


 
To download a copy of this form:
medication_permission_slip.doc
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