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ELC Release Form
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Early Learning Center Release Form
*
My chld will arrive at the program:
Supervised walk
Unsupervised walk
Public/Private van
Program bus/van
Contract/van
Private transportation arranged by parent
Other
*
My child will depart from the program:
Supervised walk
Unsupervised walk
Public/Private van
Program bus/van
Contract/van
Private transportation arranged by parent
Other
*
Child's Name
*
Parent Email
My child may be released from the Early Learning Center program to the following people:
If there are no names filled out, we will assume your child cannot be released to anyone other than parent(s).
Person 1
First and Last Name
Relationship to Child
Address
Cell Phone
Email Address
This will be used to add them to Remini as an approved pick up person as well.
Person 2
First and Last Name
Relationship to Child
Address
Cell Phone
Email Address
This will be used to add them to Remini as an approved pick up person as well.
Person 3
First and Last Name
Relationship to Child
Address
Cell Phone
Email Address
This will be used to add them to Remini as an approved pick up person as well.
Person 4
First and Last Name
Relationship to Child
Address
Cell Phone
Email Address
This will be used to add them to Remini as an approved pick up person as well.
Tue, May 7 2024
29 Nisan 5784
Tue, May 7 2024 29 Nisan 5784
