"Off Site Activities Permission Form" - Massachusetts

Off Site Activities Permission Form is a legal document that was released by the Massachusetts Department of Early Education and Care - a government authority operating within Massachusetts.

Form Details:

  • Released on January 22, 2010;
  • The latest edition currently provided by the Massachusetts Department of Early Education and Care;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Early Education and Care.

ADVERTISEMENT
ADVERTISEMENT

Download "Off Site Activities Permission Form" - Massachusetts

Download PDF

Fill PDF online

Rate (4.8 / 5) 103 votes
THE COMMONWEALTH OF MASSACHUSETTS
Department of Early Education and Care
OFF SITE ACTIVITIES PERMISSION FORM
Section 1 - Program completes prior to parental consent
Program: ___________________________________________________________________________________
Name of Educator(s) responsible for child: _______________________________________________________
Name of off-site location and address: ___________________________________________________________
____________________________________________________________________________________________
Date of off-site activity: _________ Time Leaving Program:_________ Time Returning to Program:_________
Method of Transportation: __________________ Fee associated with activity (if any): ___________________
**NOTE** Each child must carry on his/her person the name, address, and telephone number of staff or child care
program whenever she/he is off the premises in care of the program.
.
Section 2 – Parent/Guardian completes prior to off-site activity
I give permission for my child to attend the above identified off-site activity
Child’s Name: ______________________________ Child’s Date of Birth: _______________________________
Parent’s/Guardian’s Name: _____________________________ Phone Number: _________________________
I authorize child care program staff to secure necessary emergency medical treatment
Name of child’s Physician, Address, phone number: ________________________________________________
_____________________________________________________________________________________________
Child’s allergies, health conditions, or Individual Health Plan: ________________________________________
_____________________________________________________________________________________________
Health Insurance Plan and Policy #: ______________________________________________________________
Emergency Contact Name: ________________________________ Contact #: ___________________________
______________________________________________ ______________________
(Parent/Guardian Signature)
(Date)
This form must accompany each child on the off-site activity
SG/LG/SAOffSitePermission20100122
THE COMMONWEALTH OF MASSACHUSETTS
Department of Early Education and Care
OFF SITE ACTIVITIES PERMISSION FORM
Section 1 - Program completes prior to parental consent
Program: ___________________________________________________________________________________
Name of Educator(s) responsible for child: _______________________________________________________
Name of off-site location and address: ___________________________________________________________
____________________________________________________________________________________________
Date of off-site activity: _________ Time Leaving Program:_________ Time Returning to Program:_________
Method of Transportation: __________________ Fee associated with activity (if any): ___________________
**NOTE** Each child must carry on his/her person the name, address, and telephone number of staff or child care
program whenever she/he is off the premises in care of the program.
.
Section 2 – Parent/Guardian completes prior to off-site activity
I give permission for my child to attend the above identified off-site activity
Child’s Name: ______________________________ Child’s Date of Birth: _______________________________
Parent’s/Guardian’s Name: _____________________________ Phone Number: _________________________
I authorize child care program staff to secure necessary emergency medical treatment
Name of child’s Physician, Address, phone number: ________________________________________________
_____________________________________________________________________________________________
Child’s allergies, health conditions, or Individual Health Plan: ________________________________________
_____________________________________________________________________________________________
Health Insurance Plan and Policy #: ______________________________________________________________
Emergency Contact Name: ________________________________ Contact #: ___________________________
______________________________________________ ______________________
(Parent/Guardian Signature)
(Date)
This form must accompany each child on the off-site activity
SG/LG/SAOffSitePermission20100122