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R A L E I G H P A R K S, R E C R E A T I O N A N D C U L T U R A L R E S O U R C E S

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This form must be complete for participants in programs at Barwell Road, Brier Creek or

Marsh Creek. Failure to complete this form could delay processing of your registration form.

Please complete in ink. Please print.

Off-premise activities refer to any activity that takes place away from a licensed and approved space.

Licensed and approved space includes primary space, outdoor space, single-use rooms or other

administrative areas that have been approved for use.

I, _____________________________ parent/guardian of ____________________________________________

name of child

give my permission to Barwell, Brier Creek or Marsh Creek Community Center for my child to

participate in an off-premise activity.

Location of off-premise activity:

Various field trip locations and activities.

Purpose of the activity:

Program and educational enhancement.

Sign below to allow your child to leave the community center building or grounds for field trips

or other activities. This authorization is valid from July 1, 2016, through June 30, 2017.

Parent/Guardian Signature_ _________________________________________ Date_ ___________________

Continued next page

2016-2017 Registration

(cont.)

Off-Premise Activity Authorization