3275 Peachwillow Lane, Walnut Creek, CA 94598

Medication Consent Form

If your child has a specific medication that needs to be administered while he/she attends day care, please complete and return the Administration of Medications Form.

Important!

  1. All medications must be stored in the original box/packaging, with unaltered labels.
  2. All prescription medications must contain the child’s name and prescription on the packaging.
  3. Please be sure to check the medication’s expiration date.

Our forms must be filled out electronically with Adobe Reader. If you do not already have Adobe Reader, you may download it for free here:

get.adobe.com/reader
Medication Consent Form
(Click to download.)
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