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Farmhands Medication Administration Policy 2026

optional: as needed

Purpose

To ensure safe and accurate administration of routine medications to all children enrolled in Farmhands Education Programs. Medication will not be administered by a Farmhands instructor except in an emergency situation. If a student requires an inhaler or epinephrine due to allergy or asthma, please read the following and then fill out the form.

Medication Administration Policy

The following requirements must be met before administering medications.

  • Written Authorization from Health Care Provider with Prescribing Authority
  • Parent written Authorization
  • Medication in the original labeled container
  • Proper care and storage of medication
  • Documentation of medication administration
  • Child cannot attend without required and completed paperwork

Inhaled/nebulized medications, emergency injections (EpiPen®), and prescribed and over-the-counter medicines require a written health care plan or instructions completed by the child’s Health Care Provider.

Parents are responsible for providing all medications and supplies to Farmhands programs. In most situations, children should not transport medications to and from camp; this includes medication placed in a backpack. Special arrangements must be considered regarding the safe transport of medications for children attending Farmhands.

Program staff may not deviate from the written authorization from the Health Care Provider with prescriptive authority.

Care and Storage:

Due to the mobile, outdoor setting of Farmhands programs, medications shall be stored in the backpack of the instructor. If additional information or plan is needed, please contact the program administrator, Andrea Coen, at 970-309-3175.


Please select who will be participating...
Minor
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First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
Information
Cell Phone
Work Phone
Preferred Hospital
Triggers
Animal Hair
Pollen
Dust
Smoke
Exercise
Weather (cold air, wind)
Hay
Illness
Other
If Other

INSTRUCTIONS FOR RESCUE INHALER USE

Give _ puffs
of __ rescue medication
__ minutes
Before
After (check one) activity.

Explanation

Repeat how often? (if needed for additional or ongoing physical activity).

I give permission for Guidestone staff to share this information, follow this plan, administer medication and care for my child and, if necessary, contact our physician. I assume full responsibility for providing Guidestone with prescribed medication and delivery/monitoring devices. I approve this Asthma Care Plan for my child.

FARMHANDS EDUCATION ALLERGY & ANAPHYLAXIS ACTION PLAN

ALLERGY TO
Child has life-threatening allergy.
Child’s EpiPen is located
History
Health Care Provider Name/Contact
Asthma*: *
No
Yes

DOSAGE

Epinephrine: Inject intramuscularly:
EpiPen® 0.3 mg
EpiPen®Jr. 0.15 mg
Administer 2nd dose if symptoms do not improve in 15-20 minutes
Antihistamine: Give __ (Medication/dose/route)
***ATTENTION..If Antihistamine given, parents will be notified to pick up their child for closer observation!*
NO -- Child has been instructed and is capable of self-administering own medication
Yes
Provider
Phone
Parent/Guardian Name
Phone
1. Emergency Contacts: Name/Relationship/Phone Number(s)
2. Emergency Contacts: Name/Relationship/Phone Number(s)

EVEN IF PARENT/GUARDIAN CANNOT BE REACHED; DO NOT HESITATE TO ADMINISTER EMERGENCY MEDICATIONS

I give permission for Guidestone and/or Farmhands personnel to share this information, follow this plan, administer medication and care for my child and, if necessary, contact our health care provider. I assume full responsibility for providing Guidestone and/or Farmhands personnel with prescribed medication and delivery/monitoring devices. I approve this Severe Allergy Care Plan for my child. This Health Care Plan will be effective for one year or unless parents and/or physician request to have changes made sooner.

First Participant's Signature*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Cell Phone
Work Phone
Preferred Hospital
Triggers
Animal Hair
Pollen
Dust
Smoke
Exercise
Weather (cold air, wind)
Hay
Illness
Other
If Other

INSTRUCTIONS FOR RESCUE INHALER USE

Give _ puffs
of __ rescue medication
__ minutes
Before
After (check one) activity.

Explanation

Repeat how often? (if needed for additional or ongoing physical activity).

I give permission for Guidestone staff to share this information, follow this plan, administer medication and care for my child and, if necessary, contact our physician. I assume full responsibility for providing Guidestone with prescribed medication and delivery/monitoring devices. I approve this Asthma Care Plan for my child.

FARMHANDS EDUCATION ALLERGY & ANAPHYLAXIS ACTION PLAN

ALLERGY TO
Child has life-threatening allergy.
Child’s EpiPen is located
History
Health Care Provider Name/Contact
Asthma*: *
No
Yes

DOSAGE

Epinephrine: Inject intramuscularly:
EpiPen® 0.3 mg
EpiPen®Jr. 0.15 mg
Administer 2nd dose if symptoms do not improve in 15-20 minutes
Antihistamine: Give __ (Medication/dose/route)
***ATTENTION..If Antihistamine given, parents will be notified to pick up their child for closer observation!*
NO -- Child has been instructed and is capable of self-administering own medication
Yes
Provider
Phone
Parent/Guardian Name
Phone
1. Emergency Contacts: Name/Relationship/Phone Number(s)
2. Emergency Contacts: Name/Relationship/Phone Number(s)

EVEN IF PARENT/GUARDIAN CANNOT BE REACHED; DO NOT HESITATE TO ADMINISTER EMERGENCY MEDICATIONS

I give permission for Guidestone and/or Farmhands personnel to share this information, follow this plan, administer medication and care for my child and, if necessary, contact our health care provider. I assume full responsibility for providing Guidestone and/or Farmhands personnel with prescribed medication and delivery/monitoring devices. I approve this Severe Allergy Care Plan for my child. This Health Care Plan will be effective for one year or unless parents and/or physician request to have changes made sooner.

Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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