Lotion Release Form
Name of Child:
Name of Lotion or Sunscreen:
Name of Diaper Cream:
No Baby Powders at Depot Daycare
Condition Being Treated:
Examples are for sun protection, sore bum and dry skin
Times Lotion needs to be applied:
Date Lotion expires:
Possible Side Effects:
I hereby give my permission for the provider to administer this medication according to the instructions above. I agree that the provider will not be held liable for any illness or injury resulting from the administration of this medication, and will not be held responsible for the reimbursement of any medical expenses resulting from such action.
Signature of Parent or Guardian
Leave this empty:
If you have questions about the contents of this document, you can email the document owner.
Document Name: Lotion Release Form
Agree & Sign