JSACP Extra Curricular Permission Form
Authorisation to leave JSACP
Students Name
*
First Name
Last Name
Year Level and Class
*
I acknowledge the following statements and accept the following conditions
*
I give permission for my child to leave the care of Jindalee School Age Care Program to participate in extra curricular activities during the times indicated below.
This is a courtesy service provided by Jindalee School Age Care Program and as such we cannot always guarantee an Educator is available to escort/remind them to attend this activity
You accept JSACP will not be liable for any extra fees or costs forfeited by their non-attendance.
I agree that depending on circumstances my child may be unescorted to/from the journey to the extra curricular activity
My child needs to check in with an educator and/or contact needs to be made with the service if the activity starts at 3pm to ensure student attendance.
I understand that at no time will JSACP educators be present at the extra curricular activity and my child will not be under the care of the Jindalee School Age Care Program
I understand that the responsibility for my child will once again be that of the JSACP when my child returns to the service based on times provided on this form
I understand that I will still be charged for the time that my child is away from the service partitipcating in extra curricular activities
I agree to notify JSACP of any any alterations/cancellations in times or when this arrangement changes
I agree to notify the service immediately if my child will be picked up from the extra curricular activity and not coming back to the service.
I agree that my child will leave the service 5minutes prior to the start of the activity to ensure they arrive on time.
I will collect my child when the activity finishes.
*
Please Select
Yes
No
Day of Activity (tick all days applicable) :
*
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
State Date of Activity
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Does this activity run all year? If no, please specify below.
*
Yes
No
End Date of Activity
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
State Time of Activity (student will be let go 5minutes prior to start time)
*
Hour Minutes
AM
PM
AM/PM Option
End Time of Activity
*
Hour Minutes
AM
PM
AM/PM Option
JSACP requires the name of the responsible adult we are signing the child above out to and who is then assuming care for the child from that point onwards. We cannot drop a child to an organisation that does not assume responsibility.
*
First Name
Last Name
Role of the responsible adult above. i.e. Coach, Teacher, etc.
*
Activity Details (e.g. soccer)
*
Location of Activity
*
Parent/Guardian Full Name
*
First Name
Last Name
Email address
*
example@example.com
Contact Number
*
Date Completing this form
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Additional Comments (If required)
Signature
*
Submit
Should be Empty: