Program Participation Details

Pick-Up Authorization Name*

Special Instructions or Additional Information*

Parent/Guardian Consent *

I give permission for my child to participate in the Adventure Club After-School Program. I understand that the program staff will take reasonable precautions to ensure the safety and well-being of my child. In case of emergency, I give permission for medical treatment to be administered if necessary. I also agree to adhere to the program’s policies and procedures.

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