Permission Slip / Parental Consent form

Permission Slip - Parental Consent Form

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

This permission form is required to attend The HUB After School Program in Langley, WA. ! The HUB follows the South Whidbey School district schedule. When the schools are open, so are we. Our hours are 1:30-5:30 Monday through Friday. check with us about summer hours. We welcome parents to call or email us if you 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 *

Allergies or health concerns *

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 HUB Youth Central, the 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 at [email protected].

Submit