Medical Form
Please fill out this form if your child will need medicine administered during classes and camps
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Student Name *
Parent Name *
Parent Contact Email *
Parent Contact Phone *
Name of Child's Primary Care Physician *
Address and Phone # of the child's primary care physician *
Medicine Name *
Dosage Instructions *
Emergency Contact(s) - Please provide name and number of atleast 2 contacts *
I understand that In case of emergency , STREM HQ admins might need to call 911 *
It is parent/ guardian responsibility to acquire doctor authorization to administer the medicine. STREM HQ is not responsible for taking any permissions for any prescription or non prescription medicines. Parents will be providing a copy of doctors note to STREM HQ for records.
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