D10 Form 2024-2025 First Aid & Personal Care Authorization

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Form D10Basic First Aid & Personal Care Authorization Form
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Family Code* This field is required.
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Email* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
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Child's NamePlease provide the child's name.
First & Last Name
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I authorize the application of the following selected basic first aid and personal care items, including generic brands, to my child as needed* This field is required.
Vaseline (for dry skin)
Cetaphil Body Moisturizer Lotion (for dry skin)
BZK Antiseptic Towelettes (a first aid wipe)
Hydrocortisone Cream 1% (an anti-itch cream)
Neosporin Ointment (a first aid antibiotic ointment)
If Other, please explain on the next page
NO, I do not authorize any of the items listed above.
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If Other, please explain
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Parent/Guardian Name (PRINT)* This field is required.I understand that it is my responsibility to inform the staff of Irvine Chinese Immersion Preschool of any changes and to fill out a new form as needed.
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Parent/Guardian Signature* This field is required.
Clear
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Date* This field is required.
This authorization will expire on 08/08/2025 or when the parent submits an updated form.
Month
Day
Year
Should be Empty: