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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:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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Timestamp

Audit

March 29, 2018 11:03 am MDT

Lotion Release Form Uploaded by Ty Singleton - ty.depotdaycare@gmail.com IP 67.2.214.155