LIABILITY WAIVER CLUB FORM
Please fill out form if your child is going to join another school club or off campus.
Email address *
Student Name:
Your answer
Parent Name:
Your answer
My child has permission to stay on campus for a school club at Highland Park Elementary
My child has permission to leave with a sibling under the age of 18 years old
Name of Person
Your answer
My child has permission to leave HP campus to go to another club
Name of the club at Highland Park:
Your answer
Name of the club: (Not at Highland Park)
Your answer
My child will return back to ASCC at this time
Your answer
My child will attend an after school event(s) (Not a club):
Month(s), Days or Date:
Your answer
Electronic Signature
I understand that my child will not be supervised or under the care of my provider Elaine Castro (Site Director) while he/she is away from ASCC Highland Park. I release my provider Elaine Castro and ASCC Highland Park from all liability while my child is away from the ASCC childcare facility or not returning back to ASCC after the club is over. *(by typing your name below you consent to these terms and agree to use of Electronic Signature)
Parental Signature (first & last name) *
Your answer
Date *
MM
/
DD
/
YYYY
Provider signature (do not fill out-for office use only)
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Austin Independent School District. Report Abuse - Terms of Service