Student Medication Release Form

Consult with your child’s physician prior to travel regarding any regularly taken medications and confirm dosage and timing (taking into consideration time zone changes in the field). Please be sure to pack any prescription or over the counter medications not listed on this form that your student may need over the course of their GO trip in a Ziploc bag labeled clearly with their name and a copy of this form. Also, ensure that any allergies or other health considerations are included in their Managed Missions profile.

Consent for Administration of Prescription & Over the Counter Medications
Please indicate whether or not you would prefer for your student or an adult team leader to be responsible for both storing and administering any prescribed medications in the field by checking the appropriate box below. Note that for security reasons students must travel with their own prescription medications packed in their personal carry-on and if indicated below will give them to a team leader once they have reached their destination.*
- I would like my student to keep prescribed medication in his/her possession and administer themselves as directed
- I would like an adult leader on the team to be responsible for both keeping and administering my student’s prescribed medication in the field

I acknowledge that all the information provided on this form is accurate and complete and consent to my child receiving their prescription medication as indicated as well as the over the counter medications I have indicated on the previous page without requiring additional consent at the time of distribution.
Today's Date*
Signature*

Minor Information