Extra Curricular Form

Extra Curricular Consent Form

Buderim OSHC
Child Name*

First NameLast Name
Date of Request*

DayMonthYear
Date
Activity*
Dates of Activity*
Start and Finish Time*

:HourMinutesAM/PM Option
Until
until :HourMinutesAM/PM Option
Day*
Escorting Requirement (Arrival)*
Escorting Requirement (Departure)*
Location*
Additional Information
Authorisation

* I understand that during the outlined time, my child will not be under the care of a Buderim OSHC educator, therefore the service is not responsible for my child for the duration of the activity.

* I understand that it is my responsibility to notify Buderim OSHC of any changes to the above information.

* I understand if I select "Child will not return to OSHC after activity" that an educator will sign my child out of the service on my behalf.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Extra Curricular Consent Form