Activity Authorization Form

I hereby grant permission for my child, ____________________________________ to use the play equipment and participate in all of the activities at:
(Name Of Childcare Service): _______________________________________________
The parent makes the following exceptions:

I understand that riding toys, slides, large climbers, chairs, wading pools, sprinklers, sandboxes and other toys are used on a regular basis. (Be Sure To Note All Your Large Equipment Here):

I also understand that helmets, and knee and elbow pads will NOT be provided by the caregiver, however, will be required for activities such as bike riding, roller-blading, skateboarding, tobogganing, etc. (To be provided by the parent.)

I will not hold the caregiver responsible for injuries incurred while using equipment at the daycare home, providing the children are supervised and the equipment is in good repair.

Comments or concerns as noted by parent:

Parentīs Signature: _________________________________________

Parentīs Signature: _________________________________________

Date: ______________________________