Name SELF-ADMINISTRATION OF PRESCRIBED MEDICATIONS Youth Orchestra of Bucks County 2022 International Tour Due: March 1, 2022 Student's first name * Student's last name * Primary Email Address (for confirmation) * Medications The above named student has been instructed in the proper use of these medications List Medication(s) * I, this child's parent/guardian. request permission for the above-named student to carry his/her medication on his/her person. * Yes No The above-named student has been instructed in, understands the purposes, appropriate method, frequency of the use of this medication. I/we consider him/her to be responsible * Yes No The above-named student is taking this medication under the guidance of a physician. * Yes No Parent/Guardian Name * Today's Date *