ON-SITE AFTER SCHOOL ACTIVITY LIABILITY WAIVER FORM
Fill out a form if your child is going to join another After School on-site club or activity program at Highland Park. We must have documentation stating where your child will be during their normal ASCC time. (1 form per club)

We love our ASCC families and always strive to provide safe and fun childcare. It is our number one priority to keep all children and staff safe. With such a large group of children, it can be a bit challenging to keep up with each student's schedule.
We want every child to be safe and in the appropriate place at the right time.

Parent responsibility and commitment to ASCC
1. It is the responsibility of the parent guardian to communicate their child's schedule and fill out the appropriate forms with ASCC.

2. A child attending another on-site club activity is absent from ASCC until the student is signed in by the caring adult staff in charge of the program to an ASCC staff.
This is an AISD After School Policy and is a liability to our program when a student is not sign in that your child has arrived safely to ASCC.

3. It is the responsibility of the parent to communicate and arrange drop off times with all club program members and ASCC staff.

4. Parents need to communicate with the other club staff member(s) that they are not allowed to let students walk by themselves to ASCC.
This is NOT the responsibility of ASCC.
Communication is a key factor between all parties involved when a student attends another club.

5. I understand that student(s) will not be allowed to return to ASCC after 4:30 pm. If your child does not return to ASCC before 4:30 pm they will not be allowed back into our program for the day. Please arrange other plans for your child to be picked up from their on-site club/activity program. I understand that at any time the ASCC program can revoke the on-site club activity program cut off time.

6. ASCC staff members are not allowed to pick up from or take students to an on-site club/activity program.

7. If a parent picks up their child from the club activity program the child can not be dropped off to ASCC.

8. I understand that at any time the ASCC program can revoke the on-site club/activity program cut off time.
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Email *
Student Name: *
Parent Name: *
The name of the Highland Park after school club or event (No clubs enter NA) *
The name of the club that is not affiliated with Highland Park. Ex - Kula or Soccer shots (write NA if no HP club) *
My child has permission to attend a club or event at Highland Park Elementary. *
Required
What day will your child be in this club or event at HP. *
Month and date club/event starts *
MM
/
DD
/
YYYY
Month and date club/event ends *
MM
/
DD
/
YYYY
My child has permission to be picked up by his/her sibling under the age of 18 years old and is older than 14 years old. *
Required
Name of the minor over the age of 14 years old
Electronic Signature
ASCC is doing our best to help and accommodate but is not obligated or responsible once a child is signed up to attend another on-site club activity program at HP. We are willing to try to accommodate as long as we feel that we can keep ASCC children and staff safe.
We have the right to change the on-site club/activity program policy if it is no longer a safe option.
We at ASCC try to do our best to make sure that students are always counted for and safe but once a student is signed out from the program or does not come straight to ASCC from an on-site club/activity program you are releasing ASCC from any liability that can occur.
I have read and understood all of the above and the following.
I understand that it is my responsibility to make sure that all 3rd party's and HP staff must walk my child to ASCC and have the caring adult sign my child in to ASCC.
I give my child permission to go to another on-site club activity program not affiliated with ASCC at Highland Park.
As a parent or guardian, I understand that my child will not be allowed to leave Highland Park Elementary or ASCC without being supervised by another adult.
I understand that on days when there is an emergency closure, it is my responsibility to arrange for pick up and/or childcare from the other on-site club/activity program that is not affiliated with ASCC. (ex: bad weather days when we must close early or any other crisis that might arise due to unexpected circumstances that involve the safety of the students and ASCC staff members) an ASCC staff member will notify parents ASAP of the closure.
Parental Signature (first & last name) *
Date *
MM
/
DD
/
YYYY
Provider signature (do not fill out-for office use only)
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