Hello, World!

OWK After school RELEASE FORM

Student Name

First Name

Last Name

Grade

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's/Guardian Name

First Name

Last Name

Mother's/Guardian Email

Fathers/Guardian Name

First Name

Last Name

Father's/Guardian Email

Home Phone

(###)

###

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Mother's/Guardian Cell Phone

(###)

###

####

Mother's/Guardian Work Phone

(###)

###

####

Father's/Guardian Cell Phone

(###)

###

####

Father's/Guardian Work Phone

(###)

###

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EMERGENCY INFORMATION (If Parent is Not Available) Adult Contact:

First Name

Last Name

Relationship

Emergency Phone

(###)

###

####

Emergency Cell

(###)

###

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CHILD’S MEDICAL INFORMATION Any health problems which program directors should know:

Medication, if any:

Allergies, if any:

Special Concerns:

Any activities child should NOT engage in:

I understand that continued participation in the After-School Program is contingent on the student’s attention to our behavioral guidelines; consistent with those of their ISD. I hereby grant permission for my child to participate in the OWK After-School Program during the 2022-2023 school year. I agree that, to my knowledge, my child is physically and medically able to participate in these activities. I acknowledge that a signed waiver of liability must remain on file with Obstacle Warrior Kids – Garland; consistent with the standard waiver all participants sign to attend the facility. If any injuries do occur to my child, I also understand that the program staff will respond in accordance with company policy. The program runs from 3:00pm–6:30pm. I understand that I can pick up my child at any time and I agree to pick up my child no later than at 6:30. There is a $5.00 late fee every five minutes you are late beginning at 6:30pm Parents or listed guardians are required to COME INTO THE FACILITY AND SIGN OUT THEIR CHILD. This always ensures their safety. If my child is not able to attend a session, I agree to notify the staff at Obstacle Warrior Kids- Garland to let them know. Parent/Guardian

I AGREE

Permission to Have Someone Else Pick Up Your Child I hereby give my permission for the following people to pick up my child from the After-School Program:

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

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Media Release

The OWK-Garland After School Program Staff may be videotaping and taking photographs of the children during the program. This documentation may be used in future brochures or posters as well as the company web page. This documentation may be used in presentations for the program. To ensure your privacy, we would like your permission to include your child in these photographs

Choose One

YES - My child does have permission for photographs to be used in future promotions or informational packages put together by the OWK-Garland After-School Program.

N0 - My child does not have permission for photographs to be used in future promotions or informational packages put together by the OWK-Garland After-School Program.