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Permission to Take Another |
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Written by Administrator
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APPENDIX XII
PERMISSION TO TAKE SOMEONE ELSE’S CHILD HOME FROM AN ACTIVITY
FORM USAGE
This form is for use by parents who wish to designate someone who is either an adult over the age of 21, or someone who, in their opinion, is a responsible person, to take responsibility for a child of theirs at an “away” activity when released by the coach/sponsor.
PARENT TO COMPLETE FORM AND GIVE IT TO THE PRINCIPAL
This form is to be completed by a parent/guardian and given by the parent/guardian to the Principal, or his designee, before the student leaves for the activity on school-provided transportation.
DESIGNATED PERSON SIGNS FORM BEFORE TAKING THE CHILD
The coach/sponsor will take the form to the “away” activity. Before releasing the child to a designated person, the coach/sponsor will require the designated person to sign and date the form. The form will then be returned to the Principal by the coach/sponsor.
STEP I
As the parent/guardian of ______________________________________, I hereby
[Name of child(ren)]
request permission, and give my approval, for the child(ren) named above to be released
to _____________________________________ at ___________________________
(Name of designated person) (Activity)
at _____________________________________ on ___________________________.
(Place) (Date)
________________________________________ ___________________________
(Signature of Parent/Guardian) (Date)
STEP II
_______________________________________ ___________________________
(Signature of Principal or Designee) (Date)
STEP III
I agree to accept responsibility for the child(ren) named herein on the date and at the activity and the place as specified above.
_______________________________________ __________________________
(Signature of Designated Person) (Date)
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