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Arts in Motion Medication Permission Form
Child's Name
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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.
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Child's Name
*
Parent's Name
*
Parent's Phone Number
*
Emergency Contact
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Emergency Contact's Phone Number
*
Parents Signature
*
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