MEDICAL AUTHORIZATION FORM

My child can carry his/her own medicine and self-administer

I, _________________________, being the parent and/or legal guardian of

______________________ (hereinafter, my child(ren) do hereby authorize my child to have the

following medicine(s) on them during the time abroad and allow them to self-administer as

needed:

(List medicine here including tylenol and ibuprofen)

____________________________________________________________________________

____________________________________________________________________________

My child has the following allergies: __________________________.(if applicable)

Date ______________________

Signature of Parent (or Legal Guardian) _____________________

MEDICAL AUTHORIZATION FORM
Cynthia Santana and Jamie Vega can carry my childs medicine and administer as
needed

I, _________________________, being the parent and/or legal guardian of

______________________ (hereinafter, my child(ren) do hereby authorize my child to be

administered following medicine(s) by Jamie Vega and Cynthia Santana during the time abroad:

(List medicine here including tylenol and ibuprofen and any special instructions, when/how

much/etc.)

____________________________________________________________________________

____________________________________________________________________________

My child has the following allergies: __________________________.(if applicable)

Date ______________________

Signature of Parent (or Legal Guardian) _____________________