Parent Permission – Off Campus Experiences

In order to participate in an off campus Service Learning activity, students must complete a risk assessment and obtain parent permission before ISY will approve the experience. Please see the risk assessment prior to providing your child with permission for this activity.
Name of Student*
Grade*
Type of service learning experience*
Adult Supervisor*
Supervisor mobile phone number
Supervisor email*
Location (full address)
Date of Activity*
MM slash DD slash YYYY
Time of Day*
Transportation
Emergency contact – Mr John Whalen, ISY Director of Health and Safety: 0950 14384
Brief description of Service Learning Activity*
I have read and understand the risk assessment for the service learning/CAS activity and I give permission for my child to participate in this off campus event.
Parent Name*
Parent Email*
Parent Signature*
Contact Number
Date*
MM slash DD slash YYYY