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Take A Break
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Release and Permission Form
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Who We Are
Overview
Mission & History
Vision
YWCA Staff
YWCA Board Members
Careers
Donors and Sponsors
Partners of YWCA Lincoln
Location
Frequent Questions
Family & Community Engagement Programs
Introduction
Circle of Security
About
Payment
Employ402
Job Outfitters
Project Restore
Wholesome Hygiene Program
Youth Development Programs
Introduction
CATCH
What is CATCH?
CATCH Student Application
Mentorship Application
Girls Circle
SMART Girls Club
About
Join The SMART Girls Club
Become A Facilitator
The SMART Girls Club Philosophy
Virtual SMART Girls Club - '21 and '22
Resources for the Girls!
Partners in the Community
Take A Break
About
Client Intake Form
Emergency Contact Form
Release and Permission Form
What You Can Do
Overview
Become a Member
Donate
Volunteer Opportunities
Volunteer Opportunities
Smart Girls Club Volunteer
News & Publications
Newsroom
Publications & Resources
Activities and Events Calendar
Donor Page
Donate
Introduction
CATCH
What is CATCH?
CATCH Student Application
Mentorship Application
Girls Circle
SMART Girls Club
About
Join The SMART Girls Club
Become A Facilitator
The SMART Girls Club Philosophy
Virtual SMART Girls Club - '21 and '22
Resources for the Girls!
Partners in the Community
Take A Break
About
Client Intake Form
Emergency Contact Form
Release and Permission Form
Release and Permission Form
Please read the following and check yes or no.
I give permission for my child to participate in Take a Break.
Yes
No
I agree to read the parent manual and support the policies stated in it to the best of my ability.
Yes
No
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In the event that my child is injured I give permissionforTake a Break staff to call a physician, ambulance or dentist to treat my child, if necessary. I understand that a concentrated effort will be made to contact me, another guardian or emergency contact. I understand that we and not the YWCA Lincoln will accept this expense.
Yes
No
I give permission for my child to attend field trips with TAB program that would include walking in the community.
Yes
No
I give permission for my child's, my families, and my own image to be used in pictures, digital images, and video for the purposes of promoting the TAKE A Break Program on social media, grant information, or other uses deemed necessary by YWCA of Lincoln and partnering organizations.
Yes
No
Parent Name
First Name *
Last Name *
Child/Children’s Name(s): (Required)
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