Instruction: This form must be completed by the parent/guardian to authorize the use of:

  • Sunscreen
  • Diaper ointment or cream

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

All OTC products must:

  • Be in the original container and, if provided by the parent, labeled with the child’s name
  • Be used according to manufacturer’s recommendation and instructions for application Not be used beyond the expiration date of the product


  • Must have a minimum sunburn protection factor (SPF) of 15
  • Shall be inaccessible to children under 5 yrs. & children in therapeutic or special needs programs

Diaper ointment/cream

  • Shall be kept inaccessible to children
  • Record of use shall be kept that includes the child’s name, date of use, frequency of application and any adverse reactions

This authorization is effective from: