Extracurricular Authorisation Form

Extracurricular Authorisation Form

Please fill out your details to participate in extracurricular activities.
Childs Full Name

First NameLast Name
School Year/Grade
Activity Name
Activity Facilitator Name
Location of Activity
Activity Date
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Start Time

Hour Minutes

AM/PM Option
Finish Time

Hour Minutes

AM/PM Option
I give consent for my child to attend the above extra-curricular activity during OSHC hours.

I understand that Mountain Creek OSHC Service will conduct a risk assessment to determine various safety factors, including the safe transfer of my child to and from the extra-curricular activity.

I understand that the OSHC educator will sign my children out at the time of their attendance at the extra-curricular activity and sign them into the OSHC
Service upon their return.

I understand that if I (or an authorised nominee) arrives to collect my child during theextra-curricular activity, I must notify the OSHC Service prior to the child leaving the premises.

I agree to notify the OSHC Service if there are any changes to my child’s attendance of the activity.
Parents Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: