Permission Slip / Parental Consent form

Permission Slip - Parental Consent Form

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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.

* Indicates required field

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.

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