Special Consent Form

Child's First & Last Name: *

Parent's Name: *

Email: By entering in my email I release Jackman Community Daycare from any & all liability and waive all claims to any & all damages whatsoever & however caused, because the Daycare permitted my child to leave the Daycare in accordance with the permission I have granted above. *

Will be picked up by (full name): *

Child's First & Last Name:

The person above can be added to my anytime pick up list:

No

Yes

Parent's First & Last Name: *

Child's Name: *

Date & Time:

Email: By entering in my email I release Jackman Community Daycare from any & all liability and waive all claims to any & all damages whatsoever & however caused, because the Daycare permitted my child to leave the Daycare in accordance with the permission I have granted above. *

Message:

My Child will be participating in (event, team, etc.) listed below and has my permission to leave the daycare early or be absent on the following dates:

Child's Daycare Room: *

Message:

To use this form, person must be at least 18 years old *

I confirm the person listed above is at least 18 years old

Child's Daycare Room: *

My child has permission to participate in before school, lunch, and/or after school activities sponsored & supervised by TDSB staff on Jackman school grounds. The Daycare has my permission to allow my child to attend these planned and/or spontaneous activities on the following dates:

They can be reached by phone at: