Off Premises Consent

Scroll

As the legal guardian for
*
I
*
give consent for the above-named individual to
*
- Leave
- Not Leave
from the site located at 1622 Turner St. Clearwater FL. 33756 (HSPFL).

I further understand that I have to arrange transportation to pick him/her up so that they may leave without disturbing or interrupting the other children.

I also understand that if named child leaves the premises without my signed consent that law enforcement shall be notified immediately by staff at 1622 Turner st (HSPFL).

Under no circumstances is Turner St (HSPFL), its Staff or HEADS staff to be held responsible for named child's actions or behavior once they leave the premises of (HSPFL) regardless of whether the child has permission or not.
Signature of Legal Guardian*
Date*

HEADS is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
It is the policy of HEADS to comply with the requirements set forth in the Americans with Disabilities Act, Section 504 of the Rehabilitation Act as well as other applicable local and state regulations. For special accommodations or to request materials in accessible format, please contact us at (813)754-5555. If you are hearing or speech impaired please use the Florida Relay Service 1-(800) 955-8770 (Voice) or 1-(800) 955-8771 (TTY).