As a requirement of Washington State Licensing ...
CLAUDIA MILLER, DIRECTOR, 425-271-3206, [email protected] P.O. BOX 2640, RENTON, WA 98056 850 UNION AVE NE, RENTON, WA 98056
As a requirement of Washington State Licensing procedures the following information must be provided for your child to use sunscreen or have a teacher or staff member apply sunscreen to your child. I give permission for the school and childcare staff to apply sunscreen to my child as needed, per instructions on the label for. I understand that I have to provide the sunscreen and no other sunscreen will be used,
Child’s Name: Name of sunscreen/SPF:
Active Ingredients: Parent’s Signature: Date:
(Note to staff: You must write down date, time and signature of staff person applying or if child applied the sunscreen themselves on the back of this form. It must remain with the sunscreen at all times.)
SUNSCREEN APPLY LOG Med: _____________________
Med: _____________________
Med: _____________________
Dosage: ___________________
Dosage: ___________________
Dosage: ___________________
Frequency: ________________
Frequency: ________________
Frequency: ________________
Date
Time
Initials
Date
Time
Initials
Date
Time
Initials
As a requirement of Washington State Licensing procedures the following information must be provided for your child to use sunscreen or have a teacher or staff member apply sunscreen to your child. I give permission for the school and childcare staff to apply sunscreen to my child as needed, per instructions on the label for. I understand that I have to provide the sunscreen and no other sunscreen will be used,
Child’s Name: Name of sunscreen/SPF:
Active Ingredients: Parent’s Signature: Date:
(Note to staff: You must write down date, time and signature of staff person applying or if child applied the sunscreen themselves on the back of this form. It must remain with the sunscreen at all times.)
SUNSCREEN APPLY LOG Med: _____________________
Med: _____________________
Med: _____________________
Dosage: ___________________
Dosage: ___________________
Dosage: ___________________
Frequency: ________________
Frequency: ________________
Frequency: ________________
Date
Time
Initials
Date
Time
Initials
Date
Time
Initials
