» Authorization Form

Authorization for Non-Prescription Skin Products

Child Information

*All fields are mandatory

The following non-prescription items may be applied to my child in accordance with the manufacturer’s instructions on the original container (please check off):
SunscreenDiaper Creams/OintmentLip balmHand sanitizersInsect repellentLotions

Jolly Ranchers daycare Inc. has agreed to provide Parent has agreed to provide
Hand Sanitizer Diapers
Hand Soap Wipes
Paper Towel Extra clothes for child(ren)

Note: Consider adding the brand name of the non-prescription items for transparency.