Required fields are marked with asterisks (*)

External Support Worker Release Form

Support persons and external personal support workers are welcome to attend our recreation programs and drop-in activities at no additional cost while supporting another individual. Support can be provided by a family member, friend, trained support worker or social worker. Support persons must be at least 16 years of age.

All support workers must comply with Clarington’s rules and regulations. Support workers may participate with the participant so that inclusion is fulfilled.

Primary caregiver, parent or guardian first name

Primary caregiver, parent or guardian last name

Primary caregiver, parent or guardian email address

External support worker first name

External support worker last name

Child/participant first name

Child/participant last name

The external support worker is

The participant’s primary caregiver, parent or guardian.

The participant’s sibling, relative, or family friend.

A trained professional from an agency.

Currently certified in Standard First Aid and CPR C (recommended).

Currently certified in Behaviour Management Systems Training.

Please list any other relevant certifications or training.

External Support Worker Program Terms

That external support worker is a minimum of 16 years of age.
To indemnify the Municipality of Clarington for any liability resulting from any act or omission of the external support worker.
The external support worker is hired by the primary caregiver, parent or guardian and is neither an employee nor an independent contractor of the Municipality of Clarington.
To inform the external support worker of their obligation to cooperate with Municipality of Clarington staff to ensure that inclusion goals are fulfilled.
To ensure that the external support worker understands and will abide by the Municipality of Clarington program policies and procedures.
That to the best of my knowledge and belief, the external support worker has never been convicted of a criminal offence for which a pardon has not been granted.

Terms and conditions

I, the primary caregiver, parent or guardian, acknowledge and agree to the above terms.

Primary caregiver, parent or guardian release.

I (primary caregiver, parent or guardian) certify that the external support worker listed above has been hired by me to provide support for my dependent while participating in a Municipality of Clarington recreation program.