Special Consent Form

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. *

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. *

Child's First & Last Name: *

Date & Time:

Child's Name: *

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

No

Yes

Message:

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

Will be picked up by (full name): *

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:

Address (should match ID)

Child's Daycare Room: *

Parent's First & Last Name: *

They can be reached by phone at:

My child has permission to participate in before school 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. Daycare staff will sign my child out of daycare on my behalf. I understand that my child will then be under the supervision of TDSB staff.