BEFORE & AFTER SCHOOL CARE
CONTRACTED CLASS RELEASE
CHILD’S NAME
___________________________ GRADE __________
CONTRACTED CLASS
INFORMATION (INCLUDING TIMES AND LOCATIONS)
MONDAY
|
TUESDAY |
WEDNESDAY |
THURSDAY |
FRIDAY
|
I
authorize the following coaches/parent volunteers/teachers are authorized to
pick up my child
from BASC and understand they will return my child to the BASC
classroom
once the class has finished:
Name/Title_________________________________________________
Name/Title_________________________________________________
Name/Title
_________________________________________________
Name/Title
_________________________________________________
I
understand by signing my signature below, I am releasing my child from the
state
certified
care of BASC and am releasing liability for my child’s well being and safety
from all BASC
staff and programs.
Print
Name: ________________________________Date: ______________
Signature:
_________________________________