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Medication Permission Form

Holy Family Day Nursery School

Please complete and print this form. Bring the signed form to school.

Parent Sign Below & Date After Printing:

Signature & Date (to be signed after printing)

Sign and date after printing this form

By printing and signing this form, you acknowledge that all information provided is accurate and give permission to Holy Family Day Nursery School to administer the medication as directed. Please sign and date the printed form before submitting to the school office.

For office use only. Please submit this form to the school office.