PLEASE take the time to read this very important paper completely. NEXT, COMPLETE AND RETURN IT TO THE OFFICE BY SEPTEMBER 14, 2009.
(ONE PER FAMILY)
Family’s Last Name: ___________________________________________________________________
Student’s First Name: _______________________________ Grade: __________________________
_______________________________ Grade: __________________________
_______________________________ Grade: __________________________
_______________________________ Grade: __________________________
I, __________________________________________________________, authorize the following Parent / Guardian Name (PLEASE PRINT)
to pick up my child / children from school. ___________________________________________ Parent / Guardian Signature
|
NAME |
PHONE NUMBER |
RELATIONSHIP |
|
|
|
|
|
|
|
|
|
|
|
|
******************************************************************************
Your child / children also need permission to walk off of the school property after dismissal. We are requesting that you sign below if it applies to you. If you do not sign this part of the form your child/children will be held in the Safety Zone area with the other students.
My child/children have permission to walk off of the school property after dismissal.
Parent/Guardian Signature: _____________________________ Date: _________________
******************************************************************************
Sometimes, during the year your child / children may be taking walks with their class around the neighborhood. If you approve please sign immediately below.
My child/children have permission to take walks with the class.
Parent/Guardian Signature: ______________________________ Date: ___________________