Permission Slip / Parental Consent form

Permission Slip - Parental Consent Form

Fill out the Form Online or print and give it to The HUB staff

This permission form is required to attend The HUB After School Program in Langley, WA. The HUB will be open for in-person student services, games, arts and crafts and socialization soon! Our hours will be 1:30-5 Monday, Tuesday, Thursday and Friday. We have safety protocols in place to reduce the transmission of Covid-19. A nurse will be performing daily health checks with every student upon entry to the drop-in center. Youth who have symptoms of illness will be sent home. We do request that if your child becomes ill and has been at The HUB in the previous week that you notify us so we can plan accordingly. We welcome parents to call or email us if they have any further questions!

* Indicates required field

Name of Youth *

First

Last

Home Address *

Parent/Guardian phone # *

Youth's Date of Birth *

Emergency Contact & Phone *

Email *

Signature *

First

Last

Date *

By clicking the Submit button below, you are authorizing The HUB Youth Central to allow your youth to participate in our drop-in program. Additionally you agree to hold The Langley United Methodist Church or The HUB Youth Central, their Board of Directors and employees harmless in the event your child becomes ill or injured while participating in our program. We care deeply about your child's health and we will do everything we can to ensure that our facility follows the CDC, Washington State and Island County Health Department guidelines for health and safety.

Questions? Please email the program manager, Shelly Benton at [email protected] or call 360.221.0969

Submit