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OSHC Mosquito Repellent Permission Form

There are times throughout the year when mosquitoes are a cause for concern. Unfortunately, they are an unavoidable hazard and the best method of protection is to use a suitable insect repellent. Staff will administer insect repellent to your child as required during the day when mosquito population is high. We use “Off” Skintastic Brand. It you would like your child to use a different brand, please provide a labelled tube/ bottle to be kept at OSHC.

Name of child *

As the parent of the above listed child, I *

DO NOT

give permission for the staff of Zuccoli OSHC to apply insect repellent to my child when required. I understand that repellent may be applied to exposed skin including the face (except around eyes), tops of ears, arms, legs, and back of necks.

I have checked all applicable information regarding the application of repellent to my child:

I do not know of any allergies my child has to insect repellent

My child is allergic to some repellents and can ONLY use the following brand(s)/type(s) of repellent (which I have provided to OSHC):

For medical or other reasons, DO NOT apply repellent to the following areas of my child's body:

Digital Signature *

Undo

Clear

Write your signature above the line

Parent/Carer's Name: *

Email *

Date *

This consent is valid for the term of your child’s enrolment at Zuccoli Primary School. This permission can be withdrawn at any time by contacting OSHC in writing.