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Afterschool+Extracurricular+and+Supplemental+
Programs+Parent/Legal+Guardian+Authorization+Form+
Required+for+participation+in+any+and+all+afterschool+clubs,+
events,+activities+or+supplemental+programs+
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__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Date the club, activity or event will begin: _______________________________________
Date the club, activity or event will end: _________________________________________
Location of the club, activity or event: __________________________________________
Name(s) of club, activity or event sponsor(s): ____________________________________
Types of guests that may attend the club, activity or event: _________________________________________________
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09:7!?H!V9G784; ________________________________"7<7=>?87; ____________________!
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EMERGENCY+CONTACT+
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Relationship to Student: ______________________________________
This form must be submitted and retained by the club, activity or event sponsor prior to student participation.!