Student Club Membership Activity Disclosure Statement And Parental Consent Form printable pdf download

Student Club Membership Activity Disclosure Statement And Parental Consent Form

Note: This is a sample activity disclosure statement and parental consent form. This information listed

here must be included in any form your school is using for parental consent. Additional information may

be added as deemed appropriate by the school administration.

[School Name]

Student Club Membership

Activity Disclosure Statement and Parental Consent Form

Under state law, a school is required to obtain written parental or guardian consent before their

student may participate in any curricular or noncurricular club that has been authorized by the

student’s school. (UCA Title 53A, Chapter 11, Section 12 - Student Clubs Act)

Your student is seeking membership in [name of club]

The club’s purpose, goals and activities as provided in the club’s application for authorization

include: [list here]

The club’s categorization, as provided in the application for authorization,

included: [list all those noted in the application for authorization]

Beginning and ending dates the club intends to meet:

The sponsor, supervisor, or monitor responsible for the club is [name here]

Include a tentative schedule of the club activities with dates, times, and places specified.

Include personal costs associated with the club, if any.

Include information about transportation, if any. (Will transportation be provided by school or

will parent be responsible to transport their student to activities)

Student Club Membership Activity Disclosure Statement And Parental Consent Form