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 on the following days and times at the following location:
Is your emergency contact different from parent/guardian listed above?
Emergency Contact Name:
I will be able to provide a packed lunch to my child from June 26th to July 21st.
May we serve snacks to your child in the event you are unable to provide a packed lunch?
May we serve lunch to your child?
Are you planning on sending lunch with your child?
Does your child have any food allergies or dietary restrictions?