Editing previous response:

Please fix the highlighted areas below before submitting.

Permission to Apply OTC Ointments

Please complete the form below. Required fields marked with an asterisk *

My permission is herby granted to Jewish Academy of Orlando personnel to administer provided OTC ointments to: *

Answer Required

Name of ointment:*

Answer Required

Directions for administering:*

Answer Required

Times to be given medication:*

Answer Required

Submitted by:

Parent Name

Answer Required

Submission date:*

Answer Required

* It is hereby understood by the undersigned that school personnel are not held liable for the administration of the above medication or for its possible side effects.

** Medication is to be brought in its original pharmacy container. Duplicate containers can usually be obtained from the pharmacist for home storage if needed. For safety and security reasons, it is mandatory that all medications be brought to school by the parent/guardian, and not sent in with the child. If the medication is sent in with the child it will not be administered.

I understand and agree*

Answer Required

Yes

Confirmation Email

Confirmation Email *

Email Required