Permission Form - Students Arriving/Departing Unaccompanied

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Permission Form - Students Arriving/Departing Unaccompanied - Ages 9 and Up

This is a permission form for students whose parents or guardians would like to grant permission for Kids Make Theatre, The Liberty Theatre, to allow their child or children to arrive and/or depart from Kids Make Theatre programming unaccompanied.

A new form must be submitted for each season (Spring, Summer, Fall or Winter programming).

We only allow this for students 9 and up. Thank you for your understanding as we support all of our kids' wellbeing and safety.
This form must be filled out completely and submitted for us to allow a student to arrive and/or depart unaccompanied.

Pin Codes

Each student will also have a pin code they need to use to check in/ out so that there is a record of exactly when they've entered or left the building.

This pin code can be any of the codes generated by the adults or the child on your Jumbula (registration platform) account.

If you don't know what your codes are, please email: adminkmt@libertyastoria.org.

We ask that you contact us immediately if you wish to change any aspect of this permission during a season - adminkmt@libertytheatre.org.

Is my child ready to arrive/depart alone?

An excellent resource comes from Scotland, in a short "Home or Out Alone" guide available here. Although it's from across the pond, it provides a useful short guide to help decide if your child is ready to stay home or go out alone.

Some final pages of the guide have been removed because the links to the agencies for additional support in this guide are all in the UK and Scotland. Please reach out to your school or other trusted community organization for additional support and guidance.

Name of Student *

Name of Adult Granting Permission *

Age of Student

Date of Birth of Student *

YYYY

Name of class/es, camp/s, workshop/s that the Student is currently or expected to be enrolled in for this Season: *

Will the student be arriving, departing or both, unaccompanied? *

Will the student be arriving/departing every time unaccompanied or are there exceptions? Please be specific with dates and other information. *

Permission

I wish to inform you that my child will be walking to/from Kids Make Theatre programming unaccompanied on a regular basis. I will notify you immediately should this arrangement change.

I fully understand that once I give permission for my child to walk to/from Kids Make Theatre programming alone, Kids Make Theatre, The Liberty Theatre, is not responsible for my child's actions or whereabouts once they are not on The Liberty Theatre's property.

By completing and submitting this form, I agree that by choosing "yes" or "no" and typing in my name, below, I have given the equivalent of my signing this permission form.

I agree to the above permission. *

Yes

Adult Granting Permission's best phone number to reach you *

Secondary phone number

Adult Granting Permission email *

Any additional information you would like us to know or be aware of?

Submit

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