EPOSHC Extra Curricular Activity Permission Form

Child's Name *

First

Last

Organisation *

Contact Name *

Contact Number *

Type of Activity *

Location of Activity *

Day

Date From *

Date To *

Time From *

Time To *

Escort to Activity *

Collection/Pick-up By *

Confirm the following *

I have communicated to my child that they are not to leave the service before being signed out by an EPOSHC Educator
I have communicated to my child that when an activity commences immediately after school ends, that they are to go to their EPOSHC sign-in area first to be signed in by an Educator
I have communicated to my child that an EPOSHC Educator will be escorting them to their activity and that whilst on route they will follow the EPOSHC Educators directions
I understand that whilst away from the EPOSHC service and at the activity that my child is not in the care of EPOSHC
I understand that responsibility for my child by EPOSHC will resume once my child is collected from the activity at the designated time
I understand that if my child is booked into EPOSHC that I will still be charged for the time that my child is away from the service
I understand to notify the service if this arrangement changes and at that time I will complete a new Extra-curricular Activities Form if required
I understand that if the information above is altered on the day, the escort will not proceed unless written authorisation is given by the parent/carer
I understand I am required to notify the service in writing if my child is no longer attending the activity as detailed above

Name *

Signature *

Date *