PERMISSION FOR TOPICAL APPLICATION

(DIAPER rash product, SUNSCREEN AND INSECT REPELLANT)

(If you would prefer to fill out a paper Permission For Topical Application Form, Please see below to download PDF.)

Child's Name

First Name

Last Name

Grade

Product Name(s)

Expiration Date

YYYY

Purpose

Diaper Rash Product

Sunscreen

Insect Repellant

Other

Application Instructions

Please include frequency and amount

Time of Day

Hour

Minute

Second

Circumstances:

Place on the Body

Face

Arms

Neck

Exposed skin

May be applied by

Please Note

• The School will not be held responsible for any adverse reactions to the products. • Please try any products at home BEFORE asking School to apply. • Children will NOT be allowed to share product nor will the School provide. • Only the registered parent or guardian is allowed to complete this form. • You MUST provide your parent code and your signature for this Consent and Waiver form to be accepted by the School.

Product Delivery Instruction

• Place product(s) in a closed plastic bag, labelling both the bag and the product(s) with your child’s name. An appropriate Prime staff member will place your submitted permission slip in the bag on receipt. • Bag containing product should be delivered directly to Prime’s School Director to be delivered to the appropriate staff member. • Do NOT send bag containing product in a lunch bag or backpack. • Each child requires their own permission slip and products.

Parent/Guardian Name

First Name

Last Name

Parent Code

Parent./Guardian Signature

I agree that writing my full names herein will be my legal signature for purposes of using this online Prime Foundation Montessori Absence Form, this e-signature will have the same effect as if I had signed my name or initials manually.

Today's Date

YYYY

If you would prefer to fill out a paper Permission for Topical Application Form, Please download PDF below.

Ensure to place product(s) and permission slip in a closed plastic bag, labelling both the bag and the product(s) with your child’s name. (Please follow Product Delivery Instructions on the PDF form.)

Permission for Topical Application PDF

PERMISSION FOR TOPICAL APPLICATION

(DIAPER rash product, SUNSCREEN AND INSECT REPELLANT)

LocationS

Hours

Contact