Topical Medication Waiver - for DocHub.pdf

Cornerstone

Child Development Center

Topical Medication Waiver

Date Child's class:

You are hereby authorized to apply the following topical medication:

First and last name of child:

Name of ointment/lotion (brand):

Directions for application of this topical medication:

In consideration of your administering the topical medication 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's name) resulting from administration of such topical medical or diaper ointment.

Parent/Guardian Signature