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Get Our Lady of Grace School Appendix 6009A 2001-2024

RENEWED EACH SCHOOL YEAR TO BE COMPLETED BY PARENT: (for all medications) Name of Student_____________________________________________________ __________________________________ Name of Medication ________________ Dose Grade_________________ ____________________ _______________ Time(s) to be given Number of Days I request that my child, named above, be assisted in taking the prescribed or over-the-counter medication at school by authorized persons and will comply with the school’s policie.

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