Medication Take-Back
Wednesday, May 13th, 2020
2:00pm-5:00pm
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Student Last Name *
Student First Name *
School *
Name of medication &/or supplies in nursing office *
First & last name of person who will pick up (This can be parent/guardian or a person you designate) *
If you have a hardship in picking up the medication/supplies on May 13th, 2020 from 2:00pm to 5:00pm, please explain below.  
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