Request for Administration of Medication for Child Care Form Request for Administration of Medication for Child Care Request for Administration of Medication for Child Care Box 1 The following section must always be completed by the parent/guardian. Check apply and complete all of the information. Prescription Medication Topical Product or Lotion Nonprescription Medication Refrigeration Required Food Supplement Modified Diet Name of Child * Date of Birth Signature of Parent Clear If you are human, leave this field blank. Submit
