Digital Permission Slip -Positive Vibes

Digital Permission Slip

This Slip Is For A Grown Parent Or Adult Guardian To Read, Disclose Important Information, Answer Honestly, Provide Emergency Contact Information and Sign.

Child's First Name

Child's Last Name

Emergency Contact #

Emergency Contact Name

Secondary Emergency Contact #

Secondary Emergency Contact Name

Does Your Child Have Any Known Allergies, Behavioral Issues, Medications Or Health Risk Of Any Kind?

Yes

If You Answered Yes To The Above Question. Please List Any Health Risk. If None Answer N/A

Please List Any Adults or Addresses Your Child Should Not Be Released To After Activity. If None answer N/A

Date

Please List The Event, Trip, Sport or Activity You Give Your Child Permission To Attend Or Participate In Today

Attention! Please Note. By Your Signature You Agree That You Have Read This Statement. Also, That You Are Aware That You Give Your Child Permission To Participate In Positive Vibes Event Or Activity Of Today. Do Note That Positive Vibes Community Group Is Not Responsible For Lost Or Stolen Property, Injury, Death, Not Responsible To Handle or Give Medication Nor Responsible For Medication Handled Improperly By You Or Your Child. Our Staff Is Backgroud Checked. Extra Trip Chaperones Are Not. We Are Not Resposible For Anything Said Or Done By Non Members. We Have TALK Policy That Is Always In Effect. Talk about Liable Keepers-A keeper is someone who is supposed to keep you safe and not bring you harm sexually, verbally, mentally, physically or emotionally. This Will Be Said During Or Event/Activity. Our Staff Is Resposible to Report All Signs Of Abuse, Neglect or Information Disclosed To Us By Underage Children. We Are Insured As Secodary Handler. Questions or Concerns Call or Text 856-462-2184

Your Signature