RELEASE AUTHORIZATION FORM
PLEASE PRINT AND RETURN TO PRESCHOOL TEACHER ASAP.
Dear Parent(s)/Guardian(s); RE: Release Authorization 2015-2016
Each student must return a signed Release Authorization Form to preschool. Please state below all, (mother, father, etc.) persons with whom you give permission to pick up and transport your child home from preschool. We also request a note if you make a change to your regular pickup routine. This is done for the safety of your child. We will not release any child unless we have prior written authorization (this form) or a note with parent signature. We also reserve the right to ask for photo identification.
Thank you in advance for your cooperation. Please let us know if you have any questions or concerns. Mrs. Laura Allison-Ms. Lorraine Cupeto
My child,______________________________________________________ , 3’s AM PM (please circle)
4’s AM PM
May be released from preschool with the following persons:
NAME RELATIONSHIP TO CHILD PHONE #
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Parent(s) Signature:_______________________________________ Date:________________________
PLEASE PRINT AND RETURN TO PRESCHOOL TEACHER ASAP.
Dear Parent(s)/Guardian(s); RE: Release Authorization 2015-2016
Each student must return a signed Release Authorization Form to preschool. Please state below all, (mother, father, etc.) persons with whom you give permission to pick up and transport your child home from preschool. We also request a note if you make a change to your regular pickup routine. This is done for the safety of your child. We will not release any child unless we have prior written authorization (this form) or a note with parent signature. We also reserve the right to ask for photo identification.
Thank you in advance for your cooperation. Please let us know if you have any questions or concerns. Mrs. Laura Allison-Ms. Lorraine Cupeto
My child,______________________________________________________ , 3’s AM PM (please circle)
4’s AM PM
May be released from preschool with the following persons:
NAME RELATIONSHIP TO CHILD PHONE #
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Parent(s) Signature:_______________________________________ Date:________________________