Form CCL.035 "Parental Permission Form for off-Premises Trips Group of Children to One Location" - Kansas

This version of the form is not currently in use and is provided for reference only.
Download this version of Form CCL.035 for the current year.

What Is Form CCL.035?

This is a legal form that was released by the Kansas Department of Health & Environment - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Kansas Department of Health & Environment;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CCL.035 by clicking the link below or browse more documents and templates provided by the Kansas Department of Health & Environment.

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Download Form CCL.035 "Parental Permission Form for off-Premises Trips Group of Children to One Location" - Kansas

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Kansas Department of Health and Environment
CCL. 035
Rev. 3/2017
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: (785) 296-1270 Fax: (785) 559-4244
Website: www.kdheks.gov/kidsnet
PARENTAL PERMISSION FORM FOR OFF-PREMISES TRIPS
GROUP OF CHILDREN TO ONE LOCATION
Name of Facility (exactly as stated on the license)
License #
Street Address of Facility
City
Zip Code
County
Children or Youth listed below may go on an off-premise trip to:________________________________________
Located at:_________________________________________________________________________________
Street
City
County
on __________________________.
(MM/DD/YYYY)
Time of Departure:_______________________ Estimated Time of Return:_____________________
Children or Youth will be traveling by:
_______
Vehicle
_______ Walking
Children or Youth will be supervised at all times by the following staff:
Staff Name_____________________________________
Staff Name ________________________________
First
Last
First
Last
Staff Name _____________________________________
Staff Name ________________________________
First
Last
First
Last
PARENT/GUARDIAN SIGNATURE GRANTING
FIRST AND LAST NAME OF CHILD OR YOUTH
PERMISSION (Include First and Last Name)
Kansas Department of Health and Environment
CCL. 035
Rev. 3/2017
Bureau of Family Health
Child Care Licensing Program
1000 SW Jackson, Suite 200
Topeka, KS 66612-1274
Phone: (785) 296-1270 Fax: (785) 559-4244
Website: www.kdheks.gov/kidsnet
PARENTAL PERMISSION FORM FOR OFF-PREMISES TRIPS
GROUP OF CHILDREN TO ONE LOCATION
Name of Facility (exactly as stated on the license)
License #
Street Address of Facility
City
Zip Code
County
Children or Youth listed below may go on an off-premise trip to:________________________________________
Located at:_________________________________________________________________________________
Street
City
County
on __________________________.
(MM/DD/YYYY)
Time of Departure:_______________________ Estimated Time of Return:_____________________
Children or Youth will be traveling by:
_______
Vehicle
_______ Walking
Children or Youth will be supervised at all times by the following staff:
Staff Name_____________________________________
Staff Name ________________________________
First
Last
First
Last
Staff Name _____________________________________
Staff Name ________________________________
First
Last
First
Last
PARENT/GUARDIAN SIGNATURE GRANTING
FIRST AND LAST NAME OF CHILD OR YOUTH
PERMISSION (Include First and Last Name)