Non-medical Product Use Waiver

You are hereby authorized to apply the following Product:

First and last name of child: _______________________________________________

In consideration of your administering the product 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 my child(ren) resulting from administration of

such product.