• LITTLE TOT'S LEARNING DAYCARE, II 1028 Schuman Place, Baldwin, NY 11510 Over-the-Counter (OTC) Topical Product Authorization Form

    Please complete this form to authorize the application of over-the-counter (OTC) topical products to your child while in care.

  • Parent/Guardian Information

  • Format: (000) 000-0000.

  • Child Information

  • Child's Date of Birth*
     - -

  • Allergy Information

  • Does your child have any known allergies?*

  • Over-the-Counter (OTC) Topical Products Authorization

    I authorize Little Tot's Learning Daycare, II to apply the following over-the-counter topical products to my child as needed and in accordance with daycare policies and applicable regulations.
  • Topical Products (select all that apply): Parents/Guardians are responsible for providing any authorized products to be used on their child unless otherwise approved by the Provider.

  • Special Instructions

  • Oral Medications
    Oral medications, including but not limited to acetaminophen (Tylenol), ibuprofen (Motrin/Advil), allergy medications, cough medications, and other over-the-counter medications, will not be administered without the required written authorization and documentation from a healthcare provider, as required by applicable regulations and program policies.

  • Parent/Guardian Acknowledgment

  • Please check each box to acknowledge:*

  • Authorization:

    I hereby authorize LITTLE TOT'S LEARNING DAYCARE, II to apply the OTC topical products selected above to my child during childcare hours as needed and in accordance with daycare policies and applicable regulations. I understand that this authorization shall remain in effect until revoked by me in writing.

  • Date Signed*
     - -
  • Should be Empty: