Sunscreen - Insect Repellent September/February

Sunscreen & Insect Repellent Authorization Form
Valid for the dates of
Child's Name*
Form Instructions
- This form is valid for the six-month period listed above
- Parents have the option of using Rocky Mountain Sunscreen provided by Learning Ladder
  - Rocky Mountain Sunscreen ingredient list is posted on the Parent Information Board
- Parents must provide their own Insect Repellent
- Products provided by parents:
  - Must be in the original bottle labeled with the child's full name
  - Product Brand Name and Ingredient strength (SPF/DEET%) must be listed on form
- Application
  - Parents should apply first round of sunscreen before arrival each day
  - Learning Ladder will re-apply before afternoon recess
  - Only School-Age Children will be allowed to self-apply Sunscreen with authorization
  - Teachers will apply ALL Insect Repellents when necessary
- Any time a different product(s) is brought in, a new form must be filled out
- Return this form along with products to the office
Sunscreen (choose one)
I authorize Learning Ladder to apply Rocky Mountain Sunscreen with SPF 30I authorize Learning Ladder to apply sunscreen that I will provideI DO NOT authorize Learning Ladder to apply sunscreen to my child
Brand Name
SPF
Sunscreen Self-Application (choose one)
I authorize my child to self-apply Sunscreen (Only School-Agers eligible)I DO NOT authorize my child to self-apply Sunscreen
Insect Repellent (choose one)
I authorize Learning Ladder to apply insect repellent that I will provideI DO NOT authorize Learning Ladder to apply insect repellent to my child.
Brand Name
DEET %
Parent Name*
Email*
example@example.com
Date*

MonthDayYear
Use the "Preview PDF" or "Print" buttons below to save or print a copy for your records, then "Submit"
Should be Empty:

Sunscreen (choose one)

Sunscreen Self-Application (choose one)

Insect Repellent (choose one)