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Authorization for Administration of Medication at School Student Birthdate Grade This form should not be used to prescribe emergency medications or injections ONLY ONE MEDICATION PER FORM Medication

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What is this form should not?

This form should not be used for tax purposes.

Who is required to file this form should not?

Individuals who are not eligible for the program.

How to fill out this form should not?

Do not provide any personal information or sensitive data.

What is the purpose of this form should not?

The purpose of this form is to gather feedback on customer satisfaction.

What information must be reported on this form should not?

No information should be reported on this form.

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