Personal Sunscreen Permission Form

PERSONAL SUNSCREEN PERMISSION FORM

Please remember that sunscreen provided from home MUST be in the original container with ingredients listed and with the child's name clearly written on the outside of the container.
Child's Name*
Permission is given to apply the following (name/type)*
Please write the name of the sunscreen here (EX: Rocky Mountain Sunscreen KIDS SPF30 Broad Spectrum)
Amount
Permission may be given for up to 12 months.
Permission valid from:

MonthDayYear
Date
To:*

MonthDayYear
1 year from today's date
Where to apply the ointment, repellent, lotion, cream, or powder:*

all exposed skinface onlyOther
When to apply the ointment, repellent, lotion, cream, or powder:

before going outside in the afternoon (please make sure that you apply sunscreen to your child in the morning)
Describe how to apply the ointment, repellent, lotion, cream, or powder.*
Apply liberally to cover all exposed skin, and gently rub into skin until it disappears
I give permission to my child care provider to apply the medication listed above as instructed:
Parent/guardian name*
Parent/guardian signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

PERSONAL SUNSCREEN PERMISSION FORM