Medication at School:
Non-Prescription (Over-the-Counter) Medications:
I, Parent's Name* Last Name* hereby authorize Breath of Life Preparatory Academy to administer the following medication to my child, Child's Name* Last Name* . I further agree to indemnify and hold harmless Breath of Life Preparatory Academy, their agents, and staff against all claims as a result of any and all acts performed under this authority.
I, First Name Last Name , do hereby state that I am the parent/legal guardian of First Name Last Name, a minor child age Age , born on Birthdate , who resides with me at Street Address City State. I authorize, for emergency purposes only, a BOLPA designated employee to transport the above minor by ambulance and consent to any necessary examination, anesthetic, medical diagnosis, surgery or treatment, and/or hospital care to be rendered to the minor under the general supervision of any physician or surgeon licensed to practice medicine in the State of Tennessee.