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JHYM Retreats Medication Schedule and/or Special Needs

 

Child’s Name_________________

 

Date of Retreat________________

 

FRIDAY

Times

Meds & Dosages or Special Care

 

 

 

 

 

 

 

 

 

 

 

SATURDAY

Times

Meds & Dosages or Special Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUNDAY

Times

Meds & Dosages or Special Care

 

 

 

 

 

 

 

 

 

 

Additional Notes:

 

 

Person & Number(s) to contact with questions or concern during retreat weekend:

______________________________________________