Extra Curriculum Activities Form

Extra Curriculum Activities

I, (enter Parent/Guardian full name)(*)

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here by authorise the staff of Samuel Gilbert Out of School Hours Care Centre Inc. to release my child/ren(*)

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from the services care on (select date) :(*)

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Select Time :(*)

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to attend Activity:(*)

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Where:(*)

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Authorised Person:(*)

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My child/ren will be returning(*)(*)

YesNo

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to the service by :

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Select Time (If returning):

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Please accept all(*)

I accept full responsibility for my child/ren during the time they are absent from the service.I accept that my child/ren attending to and from activities during an OOSH session will not be under the direct supervision of the services educators.I accept that I am required to sign my child/ren out of the service if I collect may child directly from the extra curricula activity.

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Parent/Guardian Name:(*)

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Email Address:(*)

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Parent/Guardian signature:(*)

Sign Above

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Date:(*)

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