Group Consent Form

Parent/Guardian Consent Form for PsyCare Summer Program

By checking the relevant box below, I affirm that my child will participate in group activities led by PsyCare mental health staff at the following location:
Is your emergency contact different from parent/guardian listed above?
Emergency Contact Name:
Emergency Contact Name:
May we serve a hot meals (breakfast and or lunch) to your child if available?
I will be able to provide a packed lunch for my child when hot lunch is not available.
May we serve snacks to your child?
Does your child have any food allergies or dietary restrictions?