Consent to Administer Over the Counter Medications
Effective 9/16/2016 - 9/30/2017

This permission slip is for youths under 18 years of age granting adult leaders permission to administer over-the-counter medications when necessary. Please read and sign the form at the bottom of the page.

If there is a continued need for multiple dosage of over-the-counter medication, an adult will be in contact with you.

It is the parent’s responsibility to resubmit this form and notify the troop if there are any changes between now and September.

This section must be signed to indicate acceptance of conditions below:
  • Yes No
    Anti-itch cream (Diphenhydramine, 2%) topical for itching, as needed
    Hydrocortisone cream (1%) topical for minor swelling reaction, as needed
    EPI auto injector for anaphylactic reaction, followed by 911 call, transport to emergency room
    Cough lozengers, as needed
    Burn cream with topical lidocaine (2%) for minor burns, as needed
    Calamine Lotion, topically, for itch/contact dermatitis, as needed, every 1 hr.
    Bacitracin, topically, for wound care/infection prevention, as needed
    Throat lozenges, by mouth, 1 tab for sore throat every 2-4 hrs. as needed
    Motrin (Ibuprofen), by mouth, per weight/age dosing for pain, as needed every 6-8 hrs.
    Tylenol (Acetaminophen), by mouth, per weight/age dosing for pain, as needed every 4-6 hrs.
    Milk of Magnesia, by mouth, per weight/age dosing for constipation, as needed every 6 hrs. (NOT more than 2 consecutive doses)
    Kaopectate, by mouth, per weight/age dosing for diarrhea, as needed every 4 hrs. (NOT more than 2 consecutive doses)
    Maalox, by mouth, per weight/age dosing for upset stomach, as needed or Tums, by mouth, per weight/age dosing for upset stomach, as needed
    Benadryl (Diphenhydramine), by mouth, per weight/age dosing for rash/itch/anaphylactic reaction, as needed, every 4-6 hrs.
    Robitussin (Guifenesin), by mouth, per weight/age dosing for cough as needed every 6 hrs.
    Bug repellent, topically, as needed every 2-4 hrs.
    Sunscreen, topically, as needed for sun exposure
  • Clear
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