MEDICATION INSTRUCTIONS

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					                   CAMP SWONDER MEDICATION FORM


Child’s Name______________________________________________________

Name of Medication________________________________________________

Physical Description of Medication_____________________________________

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Day/s to Receive Medication_________________________________________

Time/s of Day to Receive Medication___________________________________

Medication Dosage_________________________________________________

Other Pertinent Information Including Side Effects of Medication______________

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Parent/Guardian Signature______________________________Date_________