Peace of Mind Form

Peace of Mind Form
2018-19 CMS ASP
CMS After School Program

At the Chadron Middle School After School Program we believe that all students and those who are caring for them at home should have peace of mind and know that their child is safe at all times when attending after school program.  We do not require that an adult enters the building to sign a student out. We release students per parent phone call or students are allowed to sign themselves out at any time. This is left entirely up to the parent or guardian.  You are the ones that know your child best. There can also be quite a bit of a difference in maturity and sense of responsibility from one student to the next. Therefore, if you would like your child to remain at ASP until a certain time, please complete the bottom half of this sheet and return it to the Middle School Office. If at any time you decide that this is no longer necessary, Just send an email or call our office to let us know.  As always, we will do our best to meet your expectations when it comes to the safety of your child. Thank you for your support.

Contact us: Kaci Swinney and Danielle Woods - CMS ASP Site Coordinators
                 Lorna Eliason - Program Director
          Program Hours: Monday- Thursday, 3:25 pm-6:00 pm
                        Early out Fridays, 1:30pm-4:30pm

Student Name:____________________  Grade:______ Date:______________

Parent Name:_______________________ Phone#:_______________________

Parent or Guardian Request:____________________________________________________________________________________________________________________________________________________________________________________________
Parent Signature:_______________________________  Date:______________

Student Signature:______________________________  Date: ______________

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