MEDICAL FORM 590-1-1.20(1)
Dear Parent/Guardian,

Except for first aid, LEAP ACADEMY personnel shall not dispense prescription or non-prescription medications to a child without specific written authorizaton from the child's physician or parent. Such written authorization will include, when applicable: date, full name of the child, name of the medication, prescription number, dosage, dates to be given, time of day to be given, and signature of the parent/guardian.

By signing this form you give LEAP ACADEMY the authorization to apply one or more of the following topical ointments/preperations to your child in accordance with the directions on the label container:

Baby wipes, band-aids, Neosporin or similar product, bactine or similiar first aid spray, sunscreen, insect repellent, non-prescription ointment (such as A & D, Desitin, Vasoline), or baby powder.



School Admission Forms are processed within 48 hours. You will receive an email confirmation when we process your application.

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