Authorization form may not be submitted via email.
the fields in the below form, print, sign and deliver to the front desk.
signed form may be faxed to: 478-745-6030
Sandy’s Sandbox Child Care & Learning Center, Inc.
MEDICATION AUTHORIZATION FORM
Dates to be
Medication should given at home whenever possible. Except for first aid,
staff members will not dispense prescription or non-prescription medication
without a specific written authorization from the child’s physician and the
parent. Diaper ointments, baby orajel, sunscreen and bug spray do not
require a physicians authorization, however, a parent authorization will
still apply. Medication will only be dispensed out of its original
container, which must be labeled with the child’s name and dosage. Medical
authorizations must be updated every Monday. When medication is brought to
the center, it is to be given to the staff person in charge for proper
storage. Appropriately licensed persons shall only administer
non-emergency injections unless the parent and the physician of the child
sign a written authorization for the child to self-administer the
injection. Medication times are 11:00 am and 3:00 pm. Medication, which is
to no longer be dispensed, will be returned to the child’s parent.
Please indicate the time(s) you want medicine given:
Signature Parent / Guardian: ______________________________
DATE: ___________ TIME: _______ AMOUNT: __________ INITIALS: ________
DATE: ___________ TIME: _______ AMOUNT:
__________ INITIALS: ________
If noticeable adverse reaction to medication, what action was taken?
SSCC&LC, Inc. Developed