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APPENDIX
EVACUATION DRILL PERMISSION FORM
We will be practicing emergency evacuation drills at various times throughout the year. This Evacuation Drill Permission Form provides a release stating that you as the parent/guardian authorize ____________________________________child care provider to take your child off the child care site for the purpose of practicing an evacuation drill.
The evacuation practice or drill may require walking your child to primary and alternative evacuation sites. This permission slip also covers my child’s participation in emergency evacuation drills throughout the year. This will involve leaving the child care facility site with providers and staff.
I will be notified in advance that this evacuation drill will take place. I know that all possible care and safety will be provided for my child. Therefore, in case of an accident I will not hold the child care site and or staff responsible.
Child Name: _______________________________________________________________________________________________ Parent/Guardian Name: ______________________________________________________________________________________ Parent/Guardian Signature: ________________________________________________ Date: ______________________________
Evacuation Site Name (Primary): ______________________________________________________________________________ Evacuation Site Address (Primary): _____________________________________________________________________________ Evacuation Site Name (Secondary): ____________________________________________________________________________ Evacuation Site Address (Secondary): ___________________________________________________________________________
Save the Children Federation, Inc. Child Care Emergency Preparedness Training Manual (2010)
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