Free Day Care Medication Record Form

Please complete this form to ensure the safe administration of medication to your child during daycare hours.
Child’s Name
Date of Birth
Parent/Guardian Name
Phone number
Medication Information
Medication Name | Dosage | Frequency | Reason for Administration |
|---|---|---|---|
Administration Record
Date | Time | Staff Name | Notes |
|---|---|---|---|
Parent/Guardian Authorization
I hereby grant permission to the daycare staff to provide and administer the medication specified above to my child.
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit the medication record form.
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Manage your daycare medication administration effortlessly with the Day Care Medication Record Form Template from Template.net. This editable and customizable template allows you to track medication details, ensuring safety and compliance. With the AI Editor Tool, you can easily personalize the form to fit your daycare’s needs, providing peace of mind for both staff and parents.