Engaging Youth in Leadership and Community Service

Medication Distribution Release

Medication Distribution Release

Youth Resources requires a medication distribution release for every student participant who will need to take prescription medication while at TEENPOWER. A parent or guardian should complete the medication distribution release below and provide their e-signature.

If you have any additional information regarding your student’s prescription medication, or you run into any issues completing the form, please call YR at 812-421-0030. Thank you!

Medication Policies

  • Prescription medication MUST be held and administered by Youth Resources while your child is at TEENPOWER.
  • All non-emergency, prescription medication must be turned in to Youth Resources at TEENPOWER check-in.
  • Emergency prescription medication – such as rescue inhalers and insulin – may remain on the student.
  • Please fill out the form below for both emergency and non-emergency prescription medication.
  • Over the counter medications like Advil or vitamins do not need to be turned in at check-in.
  • TEENPOWER staff will have over the counter medication that can be provided to your student with parental consent via staff phone call or text message.

How to Bring Your Student’s Medication to TEENPOWER

  • Prescription medications must be brought to TEENPOWER in the original pharmacy bottle.
  • The label on the pharmacy bottle should meet the requirements for the physician’s signature.
  • Prescription medication requires written permission (below) from parent/guardian stating the amount of medication, hours for administration, and period of time that the medication is to be continued.
  • Medications must be picked up at TEENPOWER check-out. Any medications left behind will be destroyed.
Step 1 of 3

STUDENT INFORMATION

PRESCRIPTION MEDICATION 1

If medication is taken more than once per day, please check ALL time periods that apply.
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