Garrison Union Free School After School Programming

PLEASE FILL OUT THIS FORM AND RETURN TO

SARAH LUSARDI (slusardi@gufs.org) NO LATER THAN SEPTEMBER 30 .

 After School Enrichment Program Release and Emergency Information Form

The following procedures have been established to ensure that all children are accounted for at the completion of GUFS After School Program. Procedures have been established because the school office officially closes at 4:00 p.m. daily and may not be available to students wishing to contact parents.

First and foremost, parents are responsible to make sure their child attends any after-school program in which he/she is enrolled. It is also the parents’ responsibility to ensure arrangements have been made for their child at the conclusion of the after-school program. Pick up is promptly at 4pm. On the 2nd incident that a child is picked up after 4:10 pm, participation in the program will need to be reconsidered. Thank you for your consideration towards our teachers.

Please fill-in what programs your child will be attending and dates.

After School Programs____________________________________________________________________________________

                                    ____________________________________________________________________________________

Dates _________________________________________________________________________________________________

Student Name_____________________________ Grade________

Student’s Teacher____________________

As the parent or legal guardian of ___________________________, I give permission for my child to participate in the After School Enrichment Program (ASEP), which I have selected and registered for.  This is a standing letter. I understand that in the unlikely event of a medical emergency involving my child, the ASEP instructor will contact 911. I give permission for my child to receive any emergency medical treatment that may be necessary. I give permission to the school to release a copy of my emergency card to the instructor, and/or ASEP Coordinator.

Parent Signature______________________________________________Date______________

My child may also be released to______________________________Phone_____________

Garrison Union Free PTA after-school activity form

Emergency Information:

Home Phone___________________________

Alternate Phone__________________________

Emergency Contact______________________

Phone__________________________________

Doctor’s Name__________________________

Phone__________________________________

Allergies or other Information_______________________________________________________