2022-23 Leaving School/Class Alone Form

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Please complete this form if you would like your child to have permission to walk home alone or walk to a designated area.

Please note that this permission is only for when school closes at normal time (3.15pm). This does not include when school closes early, after after-school clubs, or if your child is sent home unwell.

This form is only for pupils in years 4 to 6. Pupils may not collect siblings in younger years to walk home - pupils in years EYFS to Y3 must be collected by a parent/carer at all times.

Email *

Name of Pupil: *

Class: *

4MM

4AH

4RW

5LA

5DS

5JT

6JU

6MA

6KT

Reason you would like them to walk home alone: *

Independence, responsibility and self-confidence

I need to pick up another child at another school

I need to pick up another child in a different class

I do not finish work until after school home time and I will meet my child at a designated area

Where will your child walk to: *

Home

Grandparents / child minder / other house

Main school gates (to be met by parent/carer)

Y5/6 school gate (to be met by parent/carer)

Skate park (to be met by parent/carer)

Sibling's class (to be met by parent/carer)

Glatton Street car park (to be met by parent/carer)

Car park at Stanground Community Centre (to be met by parent/carer)

My child must wait for their sibling who is also in Years 4-6 and walk together (the older sibling will collect the younger): *

Yes

Days they will be walking alone: *

Monday

Tuesday

Wednesday

Thursday

Friday

Required

Permission - tick box to electronically sign here
*

I give permission for my child named above to walk home alone and I know once they leave the school site my child is my responsibility

Name of Parent: *

Date *

YYYY

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