Release/Pick-up Authorization

I understand that my child will not be permitted to leave with anyone other than the person(s) I have listed below. I give permission for the following person(s) to pickup my child from the school-age program:

Child's name:
Authorized person(s) for release/pick-up:
My relationship to the child:
Signature:
日期:

Release/Pick-up Authorization

I understand that my child will not be permitted to leave with anyone other than the person(s) I have listed below. I give permission for the following person(s) to pickup my child from the school-age program:

Child's name:
Authorized person(s) for release/pick-up:
My relationship to the child:
Signature:
日期: