Topical Application- Including Hand Sanitizer
Child's Name
*
First Name
Last Name
First Name
Last Name
First Name
Last Name
I give permission to the staff of Woodside Montessori Academy to apply the following to my child:
*
Sunscreen
Insect Repellent
Diaper Rash Ointment
Hand Sanitizer (to be applied under the direct supervision of Woodside staff. Children are not permitted to use it independently.)
On the following dates: (include dates your child will be attending the summer program)
Special instructions:
Please confirm the following statements are true and accurate:
The bug spray/sunscreen/diaper rash ointment being provided to the staff at Woodside Montessori Academy is clearly labeled with my student's name.
The bug spray/sunscreen/diaper rash ointment being provided to the staff at Woodside Montessori Academy has been used on my child before with no adverse effects.
Name
*
First Name
Last Name
Signature
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: