Medical directives for cm yukon

MEDICATIONS CONSENT H.7
Double-sided
The information on this form may be used by GGC representatives or medical personnel to administer or authorize appropriate health care or medical attention for the participant, if needed. The Medications Consent is used only for Red level activities/camps more than four hours away
from emergency medical assistance. The Medications Consent form may also be used for
international travel (72 hours or more) or large events (e.g., provincial, national or international camp). Information for Guiders:
Medication is only offered to participants if it is absolutely necessary to continue the activity. Provide parent(s)/guardian(s) with the list of medications that will be in the first aid kit using the chart on the next page. You must include the brand name of the actual medication that you will be carrying. Parent(s)/guardian(s) are to place their initials by each medication to indicate that it may be given to their daughter/ward. This information must be carried along with the first aid provisions and consulted when medications are offered. The Medications Consent must be renewed before each applicable activity/camp. Consult with your local pharmacist for advice on directions for medications listed and Information for Parents/Guardians:
Guiders are not permitted to give any medication to your daughter without your permission. In the event of an emergency, every effort will be made to contact you. However, due to the nature of the activity, the group may not be within range for a phone or cell phone. Please complete this form to grant us permission to administer medication in the event that we are unable to reach you and your daughter is unable to continue the activity without medication. If your daughter/ward is known to have anaphylactic reactions, it is strongly recommended that she carry two EpiPens and that you discuss with the first aider the capacity of the group to safely manage her well-being and health in the environment she will be traveling through.

As parent/guardian to ___________________________, I ____________________________

(name of participant)
(name of parent/guardian)
hereby give permission to the first aider listed below to administer medication to my child/ward
as outlined on the reverse.
Name of first aider:

Renewal:
This form is valid for one year. It must be reviewed prior to all activities. If there are no changes,
parents/guardians indicate renewal by signing below. If there are changes, please complete and submit a
new H.7 form.
MEDICATIONS CONSENT H.7
Double-sided
Participant’s name: _____________________________________ Medications
Note: Only the brands listed on this form may be used. Follow the dosage instructions on the packaging. Custodial
Parent/guardians initial
Brand in First Aid Kit
Medication
those medications that
(Brand name must be listed)
can be given to their
daughter/ward.
reactions such as hives, redness and swelling We protect and respect your privacy. Your personal information is used only for the purposes stated on or indicated by the form. For complete details, see our Privacy Statement at www.girlguides.ca or contact your provincial of ice or the national office for a copy.

Source: http://forms.girlguides.ca/Shared%20Documents/healthforms/H7.pdf