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2. Camper*
3. Parent/Guardian*
5. • Medication must accompany the child in original container and be turned into Camp Director.
   • For medication to be administered the child must see the Camp Director or designee.
   • Medication is NOT to be kept in lunchboxes or backpacks or with your child.
   • A new form must be filled out for each additional medication.
7. I hereby grant permission to the Day Camp Director or designee to assist in the administration of the following medication to my child:
9. Name of Medication*
10. Dosage*
12. Treatment of*
13. Administration Time*
15. Physician Name*
16. Number*
18. Amount given to staff*
20. WAIVER TO ADMINISTER MEDICATION*

    I, the parent/guardian, recognize that the Branson Parks and Recreation Day Camp staff member, who will be responsible for ensuring the above medication, is not a pharmacist and accept full responsibility for ensuring the above medication and further acknowledge that neither such a person or the City of Branson shall have any responsibility or liability arising from the above listed child taking medication in accordance with the instructions on the label. I, the parent/guardian, also authorize a Branson Parks and Recreation Day Camp staff member to administer the medication listed above.

    1. Accept
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

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