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Permission Slip / Parental Consent form
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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
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.
You must check all these boxes to give full parental consent for an unaccompanied youth.
This is your electronic signature, giving The HUB permission.
By clicking the Submit button below, you are authorizing and signing an Unaccompanied Youth Release form.
Questions? Please email the program manager at
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