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Travel and Activity Authorization

Permission(Required)

Blanket permission for this activity

Special 1-time permission only

Blanket permission for all given activities

I,(Required)

Parent/guardian of(Required)

Trips in the van/automobile (facility or parent owned)(Required)

Field trips away from the facility’s

Parent/guardian signature(Required)

Date(Required)

This authorization is valid from(Required)

To(Required)

In addition, the facility has planned activities outside the fenced area of the facility.(Required)

I will allow my child to play outside the fenced area; or

I will not allow my child to play outside the fenced area.

Parent/guardian signature(Required)

Date(Required)

This authorization is valid from(Required)

To(Required)

Email Address