Aide/Professional Behavioral Specialist Form

Aide/Professional Behavioral Specialist Form

Parents/Guardians: please submit this form (7) calendar days prior to child's activity.
Individuals entering a City of Fremont Recreation Services program, camp, or class as a one-on-one adult aide to assist OR as a professional behavioral specialist to monitor/observe a registered child at the request of the parent/guardian, must be verified and approved in advance.

Once this form is completed, City of Fremont Recreation staff will send a form to the aide/specialist to sign via DocuSign. This must be completed before the aide/specialist attends your child's activity.

For questions, please email regerec@fremont.gov or call (510) 494-4300.
Parent/Guardian Name*

First NameLast Name
Email of Parent/Guardian*
example@example.com
Phone Number of Parent/Guardian*
Please enter a valid phone number.

Participant Information

Please provide information regarding your child and activities they are registered for.
Participant Name*

First NameLast Name
For each registered activity that the aide/specialist will attend: please list the following:
- activity name
- activity number
- date(s)*
- time(s)*
(Example: Sunnyside Camp, #1234, June 7-10, 9am-3pm).

*Please note the specific time the aide/specialist will attend (not the time the activity takes place)
Activity Information*
Please list each activity your child is registered for.
Additional Information
Optional: Please provide any additional information you think might be helpful for staff.

Aide/Professional Behavioral Specialist Information
Name of Aide/Specialist*

First NameLast Name
Email of Aide/Specialist*
example@example.com
Phone Number of Aide/Specialist*
Please enter a valid phone number.
Agency/Organization of Aide/Specialist*
To my knowledge, the person listed above has undergone tuberculosis testing and a criminal background check in connection with their employment.*

YesNo
This person will be doing the following:*

Monitoring/Observing my childAssisting my childOther
Letter of Verification

Please submit a letter that verifies aide/specialist employment with their agency.
Cancelof
Additional Aide/Specialists or Additional Information
Please list any additional aides/specialists (include: name, email address, phone number, agency/organization name) that will be assisting/observing/monitoring your child.
Should be Empty:

Participant Information