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Permission to Apply Diaper Ointment or Creams
Child's Name
I, the parent/guardian of the above named child, give permission for the staff of Handled With Care to apply the following topical diaper ointment/cream that I have provided for my child.
Name of Diaper Ointment or Cream
Apply the following amount of ointment or cream:
Thick Coating
Thin Coating
Apply at the following times:
When skin in diaper area is red
When rash is present in diaper area
After each bowel movement
With each diaper change
Apply at specific time
DATE
Signature
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