WWW Authorization for Treatment (Parent Form) 12 Authorization for Treatment Student Name* Grade* Name of Parent/Guardian completing form:* Email of Parent/Gurdian:* Non-prescription medications listed below will be in the first aid bags to administer to students as appropriate: Please cross out any medications NOT to be given to your child by the Doctor or designated employee of ISY.medications Paracetamol/Tylenol – fever or pain Antihistamine – relief of allergy Antacid – for upset stomach Strepsil lozenges – for sore throat Eye wash – normal saline Lion Plaster – muscular pain DicloFenac Spray – muscular pain medications Ibuprofen – for fever or pain Calamine lotion – for mild allergy Calagel – for mild allergy Voltex cream – for sprains Motillium – Immodium – diarrhoea Electrolytes – dehydration Inhaler (Ventolin) – asthma/reactive airway Health concerns:Medication to be taken while on field trip (with written directions):(Please note medications cannot be kept by the students)AllergiesSpecial food considerations: Vegetarian Other Authorization for ParticipationStudent Name* Grade* Please sign below to indicate that you have read and understand the student behavior expectations, and have completed the authorization for treatment form. Please indicate that you give permission for your child to participate in the activities listed below.Activites* Hiking Riding in an Ox Cart Riding in a Boat In the event that ISY cannot contact you or your designated guardian, then I authorize an ISY Trip Leader or Administrator, under advice from the doctor, to make decisions regarding treatment and evacuation. I hereby authorize the school to provide, arrange for, or authorize necessary emergency medical treatment for my child. I further release, waive and agree to indemnify and hold harmless and reimburse ISY, its staff, and their successors and assignees from and against any claim which I, any other person, firm, corporation or entity may have or claim to have, known or unknown, directly or indirectly, from any losses, damages or injuries arising out of, during or in connection with my child’s participation in the field trip or the rendering of any emergency medical procedures or treatment.Signature*Date MM slash DD slash YYYY Name of Medical Insurance Policy Number Emergency contact information, if different from what I listed in the school databaseName Mobile Number