I give permission for my teen to receive the over the counter (OTC) medications that do not require a prescription as deemed necessary by Y2I Staff and/or Medic.

Oral OTC

• Acetaminophen

• Antacid

• Anti-constipation

• Anti-diarrhea

• Antihistamine

• Anti-motion sickness

• Anti-nausea

• Cough drops

• Cough Suppressant

• Decongestant

• Ibuprofen

• Naproxen

• Topical OTC

• Antibiotic cream

• Anti-itch

• Sunscreen

I/We fully consent to my/our teen receiving the OTC medications listed above as deemed necessary by the Y2I Staff and/or Medic. Fully Consent

I/We do not consent to my/our teen receiving OTC. Do Not Consent

E-Signature of Teen (Full Name)

Teen Email

E-Signature of Parent/Guardian 1 (Full Name)

Parent/Guardian 1 Email

E-Signature of Parent/Guardian 2 (If applicable)

Parent/Guardian 2 Email (If applicable)

By selecting "We Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. 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. We Accept

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