Sunscreen Authorization Form

Authorization Form for Non-Prescription Over-the-Counter Skin Products

This form must be completed by the parent/guardian to authorize the use of sunscreen. Sunscreen will be applied to children in the aftercare program.

Arlington Montessori House has my permission to apply the non-prescription over-the-counter (OTC) skin product(s) listed below to my child,

Child's name

Sunscreen Product Name

Banana Boat Sport Ultra SPF 50 Sunscreen Lotion (provided by AMH)

Known Adverse Reactions (if any):

Parent's Authorization

First Name

Last Name

Today's Date

**FORM EXPIRES ONE YEAR FROM THIS DATE.

YYYY