Permission Slip / Parental Consent form

Permission SLip - Parental Consent Form

Fill out the Form Online

This form is an Unaccompanied Youth Release Form. If you wish to grant your child permission to sign out and leave The HUB at his/her discretion, please complete and electronically sign the form below. Or download, print, sign the attached form and give it to The HUB staff.

Name of Child / Unaccompanied Youth *

First

Last

Check every box to give permission. *

I give my child permission to sign-out and leave The HUB after school program at his/her discretion. I accept full responsibility for the child named above. I agree to assume all risk of any personal injury or damage or loss, which he/she may sustain as a result of his/her release from supervision by The HUB Staff. Option I agree to waive and relinquish all claims and hold harmless The HUB, its parent non-profit The HUB Youth Central, its officers, agents and employees from any and all claims related to unaccompanied youth released from The HUB program.

Email *

Signature *

First

Last

Date *

By clicking the Submit button below, you are authorizing and signing an Unaccompanied Youth Release form.

Questions? Please email the program manager at thehub@whidbey.com.

Submit

Download, PRINT, SIGN, And Turn In

Instead of submitting an electronic signature, you can download, print, sign the attached form below and give it to The HUB staff.

Parental Consent - Unaccompanied Youth Release Form
File Size:	103 kb
File Type:	pdf

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