Permission to Administer Medicine Form

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Please give details below about your child's medication. Please make sure you personally give the medicine to a member of staff. Do not give the medicine to your child to pass on or leave it in your bag. Medicine must have a prescription label and be clearly labelled with the child's name and dosage instructions.

Email *

Child's name *

Medical condition

Name of medicine required: *

Frequency & Dosage: *

Any other information

Date of authorisation *

YYYY

I consent to DFJ Multisports giving my child the medicine detailed above *

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