Child Offsite Consent Form
Complete this form to give permission for a child to participate in an offsite activity and provide the information needed for supervision and emergency contact.
Child Information
Child's Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Grade / Age Group
*
Please Select
Infant
Toddler
Preschool
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Other
Identification or Supervision Notes
Parent / Guardian Information
Parent / Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Guardian
Step-parent
Grandparent
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method
*
Phone
Email
Text Message
Other
Emergency Contact and Medical Notes
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Known Allergies or Medical Considerations
Special Instructions for Supervision, Medication Handling, or Accessibility Needs
Offsite Activity Details
Activity Name or Destination
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Return Time
*
Hour Minutes
AM
PM
AM/PM Option
Pickup / Drop-off Location
*
Transportation Method or Arrangement
*
School Bus
Parent/Guardian Drop-off
Private Vehicle
Public Transit
Walking
Other
Itinerary or Supervising Staff Notes
Consent and Authorization
Parent / Guardian Signature
*
Submit Consent
Submit Consent
Should be Empty: