(Fill out and give a copy to the sitter)
Medications
: (list names, quantity to be taken, and at what time or frequency)
Permission to dispense medication:
I give permission to dispense my child's medication as instructed above.
________________________
Signature of parent/date
Food - likes/dislikes/allergies:
Books: favorites
What does child enjoy doing?
TV, Movies & Computers - likes/dislikes/not allowed
Sports - likes/dislikes/not allowed