Irvine, CA · Orange County
Medicine Log and Administration Sheet
Parents or guardians complete this sheet with a participant’s emergency contacts, medical information, and medication details for a City of Irvine program.
What this form is
This sheet records a participant’s emergency contacts, program or activity, allergies or diagnosed conditions, and medicine administration details. A parent or guardian completes it when a participant’s medication is involved in a City program, reviews medication administration with program staff, and signs the authorization and release. The form says it is for City staff use and should stay with medication while in the City’s possession.
Who needs it
A parent or guardian of a child or participant whose medication is kept by the City or carried during a City program should complete this sheet.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the parent or guardian and a City representative sign and date it.
How to submit this form
- 1
Download the Sheet
Download the Medicine Log and Administration Sheet PDF.
- 2
Complete Participant Details
Enter the participant’s personal information, emergency contacts, program or activity, and medical or allergy information.
- 3
Review Medication Arrangements
Review medicine administration with program staff before the first program, class, or activity meeting.
- 4
Sign and Date
The parent or guardian and a City representative sign and date the sheet.
- 5
Check Submission Instructions
The form does not specify a submission method; check the city website for current contact details.
Frequently asked questions
- What information does the Medicine Log and Administration Sheet collect?
- It requests participant and emergency contact information, program details, allergies or diagnosed medical conditions, and information about medicine administration.
- Who completes the Medicine Log and Administration Sheet?
- The form states that the information is provided by the child or participant’s parent or guardian, who also signs the authorization and release.
- Do I need a notary for the Medicine Log and Administration Sheet?
- No. The parent or guardian and a City representative sign and date the sheet; it does not call for a notary.
- How do I submit the Medicine Log and Administration Sheet?
- The form does not specify how to submit the sheet. Check the city website for current contact details and instructions.
Need something notarized?
This Medicine Log and Administration Sheet doesn’t need a notary — but if you have another Irvine form that does, a commissioned online notary can help.