OTC (Over the Counter) Medications Permission Form
This form indicates your wishes regarding the Merion Mercy Academy Student Health Center's clinical staff's authorization to administer OTC (Over the Counter) medications to your daughter, as needed, during the school day.  

eSignature:  Your electronic signature on this form is the legal equivalent of your manual/handwritten signature. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the validity of your E-Signature.  

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Email *
Parent/Guardian Name: (eSignature) *
Relationship to student: *
Student First Name: *
Student Last Name: *
Student Year of Graduation: *
Required
Please check the OTC medications below for which Merion Mercy Academy's Student Health Center staff has permission to administer to your daughter.  If you do not wish to give any permissions please check "NONE OF THE ABOVE" at the bottom of the list.   *
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