Diaper Rash Ointment Waiver
You are hereby authorized to apply ointment to:
Child’s Full Name:
Child’s Classroom:
Name of Ointment (Brand):
We will apply ointment as needed during diaper changes.
In consideration of your administering the diaper cream as described in the foregoing, the undersigned hereby
agrees that neither the Child Development Center, nor any of their employees, agents, officers, or board of
directors will be held liable in any way for any injury, loss, death or damages arising out of or resulting from
administration of the foregoing described ointment, and further holds harmless and releases the Child Development
Center, their agents, employees, officers, and board of directors from liability for any claim by or in behalf of
child named above resulting from administration of such diaper ointment.
Parent/Guardian Signature:
Date: