YR 5&6 - Walk home alone mobile phone consent form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

At Grafton Primary, only children in Year 5 and Year 6 are allowed to leave school on their own at the end of the school day. Therefore, all parents in Year 5 and 6 must complete this form.

If your child will be carrying a mobile phone with them, they should hand the phone to their teacher at the beginning of the day and collect it at the end of the day.

Before making a decision about whether or you want your child to walk home on their own, please consider your child’s maturity and this level of responsibility, as well as the distance from school and the safety of the route.

All other children need to be collected by an adult (it is not appropriate for an older sibling in Key Stage 2 to walk them home).

This consent form must be submitted before children can walk home alone.

Please note: If your child needs to leave school before home time/ the end of the school day, an adult will need to collect them.

Child's full name *

Child's Class *

5 Alder

5 Maple

5 Redwood

5 Rowan

6 Beech

6 Holly

6 Mulberry

6 Willow

I would like my child to leave school on their own at the end of the school day. *

Yes

I would like my child to leave school on their own at the end of the school day on the following days. *

Every day

Monday

Tuesday

Wednesday

Thursday

Friday

I do not want my child to walk home alone

Required

Will your child be bringing a mobile phone to school? *

Yes, my child will walk to school / home alone and will bring a mobile phone to school.

Clear form

Never submit passwords through Google Forms.

This form was created inside of Grafton Primary School. Report Abuse

Forms