I authorize the following individuals to pick up my child from the tutoring program. I understand that my child will only be released to the individuals listed below, unless I provide written notice of changes.
Authorized Individuals
Emergency Contact (if different from parent/guardian):
Important Notes:
A valid photo ID may be required at the time of pick-up. The program reserves the right to refuse release of a child if proper identification is not provided.
Changes to authorized personnel must be submitted in writing.
I understand and agree to the above terms.
