WPCC SUNSCREEN PERMISSION FORM (updated April 2023)

WPCC SUNSCREEN PERMISSION FORM
White Plains Children's Center staff can apply sunscreen to children in the afternoons before playing outside. If you would like your child to receive sunscreen application in the afternoon before going outside, please complete the form below. We provide the sunscreen and a handout with details about the sunscreen is shown below. We CAN NOT apply sunscreen to any student who does not have an up-to-date signed permission form.

We will not be applying sunscreen in the AM, children need to arrive with sunscreen already applied. If you would prefer to provide your own sunscreen, it must be commercially bottled (ie: not homemade), labeled with your child's full name, and not expired. In these cases please complete the personal sunscreen form linked here - https://form.jotform.com/201864137287157
Child's Name*
Permission is given to apply the following (name type)
Amount
Permission may be given for up to 12 months.
Permission valid from:

MonthDayYear
To:*

MonthDayYear
Can't exceed 1 yr 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: