Sunblock Authorization Form

1 Step 1

This form must be completed by the parent/guardian to authorize the use of sunblock.

Little Hoku Montessori Academy has my permission to apply non-prescription over-the-counter (OTC) skin product(s) listed below to my child:

Child NamePlease enter your child's full name

Product Name(s)Please enter the product name you approve to be applied on your child's skin. You may enter multiple or "any" if you have no preference.

Known Adverse Reactions (if any)

This authorization's START date

This authorization's END date

Parent/Guardian NameParent Name

Signature

Parent/Guardian SignaturePlease sign here to authorize the application of non-prescription, OTC sunblock products as listed above.

(Sign Here)

Clear Signature

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This form must be completed by the parent/guardian to authorize the use of sunblock.

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Sunblock Authorization Form

This form must be completed by the parent/guardian to authorize the use of sunblock.