J4TH Topical Ointment Form

TOPICAL OINTMENT FORM
Name of Child*
Topical ointments are to be applied as requested by the parent or guardian. Ointments must be over-the-counter and must be approved to be used on children. If ointment is prescribed by a physician, a physician’s note must be filled out. Ointments should be applied at home at least once to test for any allergic reaction. Ointment should be in its original packaging and must be labeled with the child’s first and last name. Topical Ointment forms are to be updated as the product expires or after one year.

I, Name of Parent*, authorize Just 4 Kids Preschool to apply ointment provided for Name of Child*. I understand that as ointment is applied, I will be provided an update via the childcare management app.
Parent / Guardian Name*
Date*

MonthDayYear
Date
Parent / Guardian Email*
You will receive a copy of this PDF you just filled out thru this email address.
Parent / Guardian Signature*

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TOPICAL OINTMENT FORM