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OWK After school RELEASE FORM

 

Student Name *
Student Name
Address
Address
Mother's/Guardian Name
Mother's/Guardian Name
Fathers/Guardian Name
Fathers/Guardian Name
Home Phone
Home Phone
Mother's/Guardian Cell Phone
Mother's/Guardian Cell Phone
Mother's/Guardian Work Phone
Mother's/Guardian Work Phone
Father's/Guardian Cell Phone
Father's/Guardian Cell Phone
Father's/Guardian Work Phone
Father's/Guardian Work Phone
EMERGENCY INFORMATION (If Parent is Not Available) Adult Contact:
EMERGENCY INFORMATION (If Parent is Not Available) Adult Contact:
Emergency Phone
Emergency Phone
Emergency Cell
Emergency Cell
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 2019-2020 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 3:00 – 6:30. 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 6:30 p.m. 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 *
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
Name
Phone
Phone
Name
Name
Phone
Phone
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 *