11 - Sunscreen Insect Repellent Permission Form

Circle of Friends

Sunscreen/Insect Repellent Permission Form
Name of Youth

First NameLast Name
As the parent/guardian of the child named above, I give permission for Circle of Friends to apply sunscreen of SPF 15 or higher to my child as specified below, when they will be engaging in outdoor activities. I understand that sunscreen may be applied to the exposed skin including but not limited to the face, tops of ears, nose, bare shoulders, arms, and legs.

Yes - I give permission to apply sunscreen.No - Do not apply sunscreen to my child's body.OtherFor medical reasons, please do not apply sunscreen to the following areas of my child's body:
If other, please explain.
As the parent/guardian of the child named above, I give permission for Circle of Friends to apply insect repellent (that may contain "Deet") to my child as specified below, when they will be engaging in outdoor activities. I understand that insect repellent may be applied to the exposed skin including but not limited to the face, tops of ears, nose, bare shoulders, arms, and legs.

Yes - I give permission to apply insect repellent.No - Do not apply insect repellent to my child's body.OtherFor medical reasons, please do not apply insect repellent to the following areas of my child's body:
If other, please explain.
I hereby agree to release, indemnify and hold harmless Circle of Friends and any of its employees, officers, board members, and volunteers from any claims, demands, or actions arising out of or in any manner based upon the application of sunscreen and/or insect repellent to my child.
Parent/Guardian name

First NameLast Name
Parent/Guardian signature

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Circle of Friends