Date *

MM

DD

YYYY

Child's Name *

First Name

Last Name

School's Provided Sunscreen *

Babyganics SPF 50 Kids Mineral Sunscreen UVA/UVB Protection Octinoxate & Oxybenzone free Water Resistant

Yes, as needed

No, I opt to not have sunscreen on my child. I understand that my child may get sunburned.

Any known adverse reactions? *

No

Yes

This authorization is effective from: *

MM

DD

YYYY

Until: *

MM

DD

YYYY

Date *

MM

DD

YYYY