Sunscreen & Insect Repellent Authorization Form
Valid for the dates of
Child's Name
*
First Name
Last 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
Products must be dropped off in the office
. Do not leave in backpacks, cubbies, or the classroom.
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
Sunscreen (choose one)
*
I authorize Learning Ladder to apply Rocky Mountain Sunscreen with SPF 30
I authorize Learning Ladder to apply sunscreen that I will provide
I 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 (select if not yet in kindergarten)
Insect Repellent (choose one)
*
I authorize Learning Ladder to apply insect repellent that I will provide
I DO NOT authorize Learning Ladder to apply insect repellent to my child.
Brand Name
DEET %
Parent Name
*
Email
*
example@example.com
Date
*
/
Month
/
Day
Year
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