1-203-489-0227
I hereby request permission for the below non-prescription topical diaper cream, medicated powder or ointment to be administered to my child by a child care staff member of The Learning Barn Childcare Center & Preschool, LLC. I understand that I must supply the child care program with the topical diaper cream, medicated powder or ointment in the original container labeled with the child’s name, name of product, and the directions for administration. This permission is limited to the following topical medications: Diaper changing or other ointments free of antibiotic, anti fungal or steroidal medications and medicated powders.
I have administered at least one dose of the above medication to my child without adverse side effects.
Parent/Guardian Signature
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