Topical Ointment and Sprays Permission Summer 2024
Child's
*
First Name
Last Name
First Name
Last Name
I give permission to the staff of Woodside Montessori Academy to apply the following to my child:
Sunscreen
Insect Repellant
Diaper rash ointment
Hand Sanitizer (to be applied under the direct supervision of Woodside staff. Children are not permitted to use it independently.)
Other
On the following dates:
Special instructions:
Please confirm the following statements are true and accurate:
*
The topical oinment/spray I have provided to the staff at Woodside Montessori Academy is clearly labeled with my student's name.
The topical oinment/spray I have provided to the staff at Woodside Montessori Academy has been used on my child before with no adverse effects.
Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
Date
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