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This form is required for each student in K - 3rd grade to attend the early release program. The form must be filled out completely.
A phone number where you can be reached immediately.
I give permission for the following person(s) to pick-up and/or drop off my child to Early Release. I understand that my child will only be permitted to arrive and/or leave with the parent/guardian or the person(s) named here unless I notify the library staff by phone at 605-353-8530 of the additional person(s) authorized to pick up my child.
1. Your child will be supervised at the designated areas of the library from 1:45 pm – 3:30 pm. At 3:30 pm, it is required that the parent/guardian or authorized person will pick up the child inside the library.
2. Children will be expected to follow the stated library policies found at https://hpl.huronsd.gov/199/Library-Policies
3. The Huron Public Library follows a zero-tolerance policy concerning conduct and behavior.
4. A student who fails to obey will receive a warning. The second offense the student will be immediately removed from the program, parent/guardian will be notified to pick up the child. Further participation in the Early Release will be determined by library staff and the parent or guardian will be notified.
5. A parent/guardian will be called to pick up a child who is sick or injured. Medicine will be not administered.
6. The library staff will not administer any medication that a child may require. Parents or guardians are required to administer medications and provide necessary care for their children.
7. A snack may be served at Early Release. It is the parent/guardian’s responsibility to provide the student with an appropriate snack for those who have restrictions due to allergies/sensitivities.
8. Children preschool and younger may not be left unattended at Early Release. A parent/guardian or caregiver (defined as 6th grade and older) is required to be in attendance and supervise the child. (See library policy for more information)
9. I agree to waive, release and discharge any and all claims for damages, death, personal injury, loss, lawsuits, expenses, and other liability of any kind, which my child may have or which may hereafter accrue as a result of my child’s participation in this program against their person or entity whether such injury or damage was foreseeable. This acknowledgment of and assumption of risk and release shall be binding upon heirs and assigns.
10. A new form will be required each school year.
I hereby grant permission to the Huron Public Library to use photographs and/or video of my student (listed above) at the Library or at Library programs in publications, news releases, online, and in other communications related to the mission of the Huron Public Library.
By checking the “I agree” box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I hereby declare that the information provided is true and correct. I have read, understand, and agree to the above rules and regulations.
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