Off-site Club Liability Waiver Form
This form is to be used if you wish to have your child attend a club or program that is off-site. By filling this form out you understand that your child will need to be picked up and dropped back off to ASCC by the off-site club staff member NOT ASCC staff members. STUDENTS ARE NOT PERMITTED TO WALK TO AND FROM THE CLUB WITHOUT AN APPROVED ADULT. Please read the entire form and answer all questions and sign below.
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 individual schedule. Communication is key between parents/guardians, ASCC staff and off-site club staff members. ASCC does not communicate with off-site clubs. No child will be permitted to leave by themselves for their well being and safety and for the safety of our program. ASCC staff members are not allowed to pick up from or take students to an off-site club. When a student returns back to ASCC the student must be signed in by the adult dropping them off at ASCC. ASCC will not allow students to return from any clubs after 5:00 pm. If a student is dropped off from their off-site club and is not signed in to an ASCC staff member before 5 pm then your student is not under our care. The child’s parents are responsible to pick up their child from the off-site club and can not come to drop the child off to ASCC after 5 pm. It is the responsibility of the parent to communicate and arrange to pick up and drop off times with off-site clubs and ASCC staff members. Please understand that at any time the ASCC program can revoke the drop-off club cut off time. ASCC is doing our best to help and accommodate but is not obligated or responsible once a child is signed out from ASCC. 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 off-site club 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 for an off-site club you are releasing ASCC from any liability that can occur. I have read and understood all of the above and the following. I give my child permission to go to another off-site club not affiliated with Highland Park Elementary or ASCC. 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 off-site club 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. *
Required
Student Name: (First & Last) *
Your answer
Student's Grade *
Your answer
Parent Name: *
Your answer
Will your child return to ASCC after his/her offsite club? *
Required
Electronic Signature
Parental Signature (first & last name) *
Your answer
Date *
MM
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DD
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YYYY
Provider signature (do not fill out-for office use only)
Your answer
Submit
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