Parent/Guardian Permission for Sunscreen and Insect Repellent Use at Saltaire Day Camp

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To be completed by the Parent/Guardian - Valid for 1 Year

CAMPER FIRST AND LAST NAME *

CAMPER AGE GROUP *

Sea Stars (preschool and Kindergarden)

Moon Jellies (rising 1st and 2nd graders)

Dolphins (rising 4th and 5th graders)

Sharks (rising 6th and above)

CAMPER BIRTHDATE *

YYYY

Sunscreen

To reduce possible overexposure to the sun, New York State Education Law allows campers who can apply sunscreen to themselves or direct a camp staff member to apply sunscreen to carry and use FDA approved sunscreen products at camp and camp sponsored events with written parent or guardian consent.

I allow my child or a camp staff to apply my CHILD'S OWN FDA approved sunscreen as needed. If my child does not have sunscreen, I allow my child or camp staff to apply the CAMP PROVIDED FDA approved sunscreen as needed. Camp Product: Blue Lizard Kids Mineral SPF 50 Sunscreen Spray (ACTIVE INGREDIENTS: Zinc Oxide 24% INACTIVE INGREDIENTS: Aphanizomenon Flosaquae Extract, Butyloctyl Salicylate, C12-15 Alkyl Benzoate, Caprylyl Glycol, Cetyl Diglyceryl Tris(Trimethylsiloxy) silyl ethyl Dimethicone, Dimethicone, Ethylhexylglycerin, Glycerin, Hydrogen Dimethicone, Hydrogenated Polydecene, Isopropyl Myristate, Pentylene Glycol, Polyhydroxystearic Acid, Potassium Sorbate, Propanediol, Silica, Sodium Benzoate, Sodium Chloride, Sodium Phytate, Sorbitan Olivate, Synthetic Beeswax, Tetrafluoropropene, Water)

I DO NOT allow my child or camp staff to apply any sunscreen -- personal or camp supplied

Insect Repellent

Insect repellents can help reduce bites from ticks and insects. Whenever possible, apply insect repellent at home before sending your child to camp. Campers may carry and use insect repellent at camp and camp sponsored events with written parent or guardian permission. If a camper cannot apply insect repellent independently, a camp staff member may assist with application. Only lotions, wipes, or non-aerosol spray products are permitted.

I allow my child or camp staff to apply my CHILD'S OWN EPA registered insect repellent as needed according to the product directions. If my child does not have insect repellent, I allow the camp staff to apply the CAMP PROVIDED EPA registered insect repellent as needed according to the product directions. Camp Product: Murphy's Naturals Mosquito & Tick Bug Repellent Spray (ACTIVE INGREDIENTS: Oil of Lemon Eucalyptus (30%) INERT INGREDIENTS: Water, Corn Ethanol (70%))

I DO NOT allow my child or camp staff to apply any insect repellent - personal or camp supplied

Parent/Guardian Signature and Contact Information

Please type your full name in the box below

Please select today's date *

YYYY

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