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Authorisation for my Child to Walk to the venue “Cypriot Community Centre” from “Earlham Primary School”

I give permission for my child to be escorted by an adult from Lollipop Art Community Ltd (teacher: Miss Claudia Ghironi) from the exit gate of Earlham Primary School to the Cypriot Community Centre (Earlham Grove, Wood Green, London N22 5HJ) in order to attend art activities organized at the venue.

Days/Time: Every Monday at 3:30 PM (waiting time: 5 minutes).

The adult will supervise the child but will NOT be responsible for any accident/incident (e.g., falls, etc.). In case of emergency, I can be contacted at the phone number provided below.

Child’s Information

Full name

Class:

Parent/Guardian Information

Full Name (Printed):

Phone Number (Emergency Contact):

Signature

Parent/Guardian Signature:

Signature

Authorisation for my Child to Walk to the venue “Cypriot Community Centre” from “Earlham Primary School”

Child’s Information

Parent/Guardian Information

Signature

Parent/Guardian Signature:

Date: