Walk home unaccompanied consent form

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Bardwell Church of England Primary School
Permission for child to walk home without an adult

Please complete the attached form if you give permission for your Y5/Y6 child to leave the premises unaccompanied at the end of the school day. Note that this permission will apply throughout the year, but we recommend that children are picked up by a designated adult from After School Clubs that finish after dark.

Pupil name *

Year Group *

Please read the following statements and tick below to confirm that these are true *

My child understands road safety

My child knows the safest journey home

My child knows that they must go straight home

My child knows how to keep themselves safe from those that may wish to hurt them

When arriving at home my child will be met by a responsible adult

I will take account of weather conditions and time of year and inform the school if I do not believe it is safe for my child to walk home on any occasion and I will arrange collection by a designated person

Required

My child is allowed to walk home on the following days *

Monday

Tuesday

Wednesday

Thursday

Friday

Required

I confirm that the above statements are accurate and give permission for the child named above to walk home without being collected by an adult. *

Additional notes/information

Parent name *

Date *

YYYY

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