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This document is a parental consent form that verifies a child's competency to self-administer medications at Tennessee 4-H Centers, including details about the medication and prescriber.

How to fill out county supplement a parental

How to fill out County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers

1. Obtain a copy of the County Supplement A: Parental Consent Form.
2. Fill in the participant's full name at the top of the form.
3. Provide the participant's date of birth.
4. Indicate the specific prescription and non-prescription medicines that the participant will be self-administering.
5. Provide the dosages and frequency of administration for each medicine listed.
6. Include any relevant medical conditions or allergies that the participant has.
7. Sign and date the form to confirm consent for self-administration.
8. Submit the completed form to the appropriate 4-H Center staff before the participant arrives.

Who needs County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers?

1. Parents or guardians of children who will be attending Tennessee 4-H Centers and need to self-administer medications.
2. Participants who require permission to carry and administer their own prescription and non-prescription medicines during activities.

For pdfFiller’s FAQs

What is County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers?

County Supplement A is a form required by Tennessee 4-H Centers that allows parents or guardians to give consent for their children to self-administer prescribed and over-the-counter medications while attending programs or events.

Who is required to file County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers?

Parents or guardians of children who wish to self-administer prescription or non-prescription medicines during their participation in Tennessee 4-H Center programs are required to file this form.

How to fill out County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers?

To fill out the form, parents should provide their child's information, specify the medications, include dosage instructions, and sign to give consent for self-administration during the 4-H activities.

What is the purpose of County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers?

The purpose of the form is to ensure that children can safely self-administer necessary medications during their time at the centers, while also providing legal consent from their parents or guardians.

What information must be reported on County Supplement A: Parental Consent Form for Self-Administration of Prescription and Non-Prescription Medicines at Tennessee 4-H Centers?

The form must include the child's name, the names and dosages of the medications, administration instructions, the emergency contact information, and the parent's or guardian's signature.