Authorized person(s) must be at least 18 years old.
Once this application is received the family coordinator will be calling to review more specific needs of your child/children.
Medication Information
Parent Request and Authorization to Administer a Prescribed Medication/Drug Treatment. To the Parent: The following information is necessary for any person to be given emergency medications. Any medication brought to any of our programs must be in its original container and be properly labeled.
Prescriber's Authorization
I authorize a trained volunteer of Under His Wings Respite to administer the medication.
I understand the person will be transported to the nearest hospital if an EpiPen is administered.

Download Forms

Please fill out the application forms and the consent form and please return them to:

Under His Wings Respite

4290 Hartland Center Road

Collins, Ohio  44726