Permission Form For Unsupervised Departure

Dear Parent/Guardian,

At Corbridge Youth Initiative (CYI), the safety and well-being of our members is always our top priority. As we update our records for the new year, we require parental/guardian consent for every young person who wishes to leave the premises unsupervised.

Main reasons for young people wanting to leave the centre unsupervised include going to local businesses such as the COOP, to local parks and to walk home.

To ensure their safety and meet our requirements, we kindly ask that you review, sign and return the attached permission form on the other side of this page, this will then be updated in our records. By granting your consent, you acknowledge that you are aware and accept responsibility for your child during the time they are not under the supervision of Corbridge Youth Initiative.

If you have any concerns or require additional information before making your decision, please do not hesitate to contact us.

Thank you for your prompt attention to this matter. Please return the completed form as soon as possible.

Warm regards,

Amber Robinson

Project Coordinator

Young Person’s Name

Date Of Birth

Parent/Guardian Name

Contact Phone Number

At Corbridge Youth Initiative, the safety of all young people attending our services is our top priority. To allow your child to leave the premises unsupervised, we require your explicit permission. By completing this form, you acknowledge and accept responsibility for your child once they leave the premises.

Please complete the following:

Please tick to all that apply.

I give permission for my child to leave Corbridge Youth Initiative unsupervised to go to local businesses such as the COOP
I give permission for my child to leave Corbridge Youth Initiative unsupervised to go to local parks.
I give permission for my child to leave Corbridge Youth Initiative to walk home.
I understand that my child will not be under the supervision of Corbridge Youth Initiative staff once they leave the premises.
I understand that Corbridge Youth Initiative cannot be held responsible for my child’s safety once they leave the premises unsupervised.
I do not give permission for my child to leave Corbridge Youth Initiative unsupervised under any circumstances.

Sign Here

Today's Date

Printed Name

Charity No: 1154200

Permission Form For Unsupervised Departure