Parent's request for the administration of medication by Mettle personnel

Parent’s request for the administration of medication by Mettle personnel

I hereby request and give my permission to the director or a delegate to administer the following medication to my child.

Name of Child(Required)

First Last

Name of Drug(Required)

Dosage(Required)

Administer at the following times(Required)

Phone number of Parent/Guardian(Required)

Signature(Required)