(if unsure of exact day, use 1)
Please list ALL medications that your youth might have the occasion to use while participating in any youth function; this includes but is not limited to allergy medication, inhalers, migraine medicines, behavior modifying medications, etc. This information will be kept confidential,
but this form will be available for those leaders of the youth during emergency situations. If none, please write NONE in this space.
Please list allergies and treatment(s) for each allergy (food, medicine, other). If none, please write NONE in this space.