Activity Check-Out Form
Record the details of a participant’s departure from an activity or program. Please complete all relevant fields.
Participant Full Name
*
First Name
Last Name
Activity/Program Name
*
Date of Check-Out
*
-
Month
-
Day
Year
Date
Time of Check-Out
*
Hour Minutes
AM
PM
AM/PM Option
Staff/Supervisor Name
*
Participant Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Check-Out
Please Select
End of Activity
Early Departure
Scheduled Pick-Up
Other
Person Picking Up (if applicable)
Pick-Up Contact Number (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Comments or Notes
Submit Check-Out
Should be Empty: