Arts in Motion Medication Permission Form

Child's Name *

I give Arts in Motion permission to give my child the following over-the counter medications, in doses listed on the medication packaging, while participating in Arts in Motion events:

For headache, menstrual cramps or injury received during an AIM event:

Tylenol/Acetaminophen

Advil/Ibuprofen

Aleve/Naproxen

For stomach upset:

Tums/Calcium Carbonate

Pepto Bismol

For allergic reaction or insect sting:

Benadryl/Diphenhydramine

My child has allergies to the following:

My child carries the following:

Epipen

Medications/Supplies for Diabetes

Other medications (please list)

Please inform us of any medical issues your child has that may affect their participation in strenuous rehearsals, performances or promotional events hosted by Arts in Motion. *

Child's Name *

Parent's Name *

Parent's Phone Number *

Emergency Contact *

Emergency Contact's Phone Number *

Parents Signature *

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