Extra-Curricular Activities Authorization Form

Complete the following form/statement/ information if you wish to permit your child to check- in and/or out of the program to participate in extracurricular activities offered on school premises. All required information must be completed in full to ensure the safety of your child. Children will only be released to adults who hold positions that include student supervision as one of their essential responsibilities, under the guidelines of the school-sponsored club or enrichment activity.

Participating Room:  ES Gym, ES Music room, E 209, E 117, E118, E119

STEM BASE works daily with the enrichment staff to ensure a safe transition to and from the club or enrichment activities As a result,  your child will continue to be listed as attending BASE and will checked into the STEM BASE program at 3:30pm after the club ends.

I understand that my child must check themselves in and out of the program in accordance with program policies, and failure to do so may result in the removal of this authorization. In that case, a parent or an authorized adult would be required to sign my child in and/or out of the childcare program. I also understand that once my child is signed out of the B.A.S.E. program, they will be supervised by the adult specified on the authorization form.