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Medication Forms

Authorization for Non-prescription Over-the-Counter Skin Products Child Day Centers

Medication Authorization Form Prescription and Non Prescription


Please note that MCH only administers life saving medications such asthma inhalers and epi-pens.  We do not administer other medications such as antibiotics, tylenol or the like.  Although our staff is MAT, CPR and 1st Aid certified we do not have a school nurse on staff.

For sunscreen and bug spray please fill out and sign both medication consent forms.

If your child is needing to keep an asthma inhaler or epi-pen at MCH please fill out the medication authorization form (included in enrollment packet) as well as the Medication Authorization form for Prescription and Non-prescription form by VDSS.  This form will need a signature from your child’s pediatrician.  Please have your child’s doctor state when medications are to be given.  For example, if this is an as needed medication please list the symptoms MCH staff should be aware of.  It is also extremely helpful if we also have an Asthma Action Plan or LAMP form from your child’s doctor.   We understand this can be a bit confusing so feel free to ask questions and we will be more than happy to assist!