Authorized Pick Up. Please list any individual who is authorized to pick up your child, including yourself. Each authorized person must be at least 16 years of age. The above-named child will not be permitted to leave the program with anyone who is not listed below. Authorized individuals must pick up the child in person and may be requested to show identification to program staff. Children will not be released to persons who fail to provide acceptable identification upon request. I authorize the following responsible persons to pick up my child from the program (attach additional pages as needed): Authorized Person Phone Number Relationship to Child Please note that children must be picked up by designated times. If an authorized adult is unable to be reached, program members will contact the local police department as a last resort to take your child home. If you are not at home, your child may be released to the Division of Family and Children Services.
Authorized Pick Up. Children will be released only to a parent or a person named by the parent. Parents or persons named by the parent must make sure that a staff member is aware of the child’s arrival and departure. Parents shall sign the child in and out by name and time of arrival and departure. Parents cannot share access codes, computer passwords, and other security measures with unauthorized people.
Authorized Pick Up. Please list any individual who is authorized to pick up your child, including yourself. Each authorized person must be at least 16 years of age. The above-named child will not be permitted to leave the program with anyone who is not listed below. Authorized individuals must pick up the child in person and may be requested to show identification to program staff. Children will not be released to persons who fail to provide acceptable identification upon request.
Authorized Pick Up. Please list other adults to whom your child may be released or who are authorized to pick up your child NAME RELATIONSHIP TO CHILD CELL PHONE ALTERNATE CONTACT NUMBER 00000 Xxxxxx Xxxxxx Xx, Xxxxxxxx, XX 00000 | T: 000-000-0000 | W: XxxxxXxxxxxXxxxxxxxxx.xxx | E: xx@XxxxxXxxxxxXxxxxxxxxx.xxx 1 Additional Information: Xxxxx's Emergency Information: Should my child become ill or suffer an accident, I hereby authorize BellaVision Montessori to administer, call for, or secure the necessary emergency care of medical attention as deemed necessary by BellaVision Montessori. I understand that an effort will be made to contact myself or the designated persons if possible, before any action is taken. I also understand that any expense incurred will be accepted by me. XXXXX's PHYSICIAN PHYSICIAN's PHONE PHYSICIAN's ADDRESS PREFERRED MEDICAL FACILITY FACILITY's PHONE FACILITY's ADDRESS I give consent for the facility to secure any and/ or all necessary emergency care for my child. Signature - Parent or Legal Guardian : Child's Health Profile (Allergies, Medication, Behavior etc) PLEASE LIST ABOVE ANY FOOD or DRUG ALLERGIES or DIET RESTRICTIONS PLEASE LIST ABOVE ANY MEDICAL PROBLEMS OR CHRONIC ILLNESS WHICH THE SCHOOL SHOULD BE AWARE OF PLEASE LIST ABOVE ANY CONTINUING TREATMENT OR BEHAVIOUR DISORDER YOUR CHILD IS RECEIVING PLEASE LIST ABOVE ANY FEARS YOUR CHILD HAS PLEASE LIST ABOVE ANY PARTICULAR BEHAVIOUR WE SHOULD BE AWARE OF Child's Additional Information (Optional) PRIMARY LANGUAGE OTHER LANGUAGES(s) SPOKEN POTTY TRAINED? Yes No In Progress PLEASE LIST ABOVE YOUR CHILD's STRENGTHS, INTERESTS AND TALENTS N/A Other If YES, Please explain :- ARE THERE ANY ASSESSMENTS, REPORTS OR DOCUMENTATION REGARDING THIS CHILD THAT WE SHOULD KNOW ABOUT? YES NO Please share below any additional information you would like us to know about your child or your family, including any areas needing special attention, as well as your goals for your child at our school. How Did You First Hear About BellaVision Montessori? Internet Search Local Bulletin FaceBook BVMS Referral Drive By Mailing List Parent Referral Other? (Specify) 2 00000 Xxxxxx Xxxxxx Xx, Xxxxxxxx, XX 00000 | T: 000-000-0000 | W: XxxxxXxxxxxXxxxxxxxxx.xxx | E: xx@XxxxxXxxxxxXxxxxxxxxx.xxx General Authorizations: Permission To Leave Gated Area Permission is hereby given for my child to leave the gated area for special reasons such as nature walks, litter pick up, etc. Although they may leave the gated area, they will not lea...
Authorized Pick Up. I understand that my child will only be released to an adult whose name is on the Emergency Contact Form unless I have given advance written authorization to the site. I understand that only adults are allowed to pick up my child. I understand that if I would like to have a minor pick up my child, I must contact the Annex Administrator for the waiver form. Picture identification is required for verification and can be asked for at anytime.
Authorized Pick Up. By checking here, you agree that you may verbally (by telephone) or in writing (by facsimile or otherwise) request that Happy Paws @ Unleashed release your dog to someone other than the person(s) listed above, and you release Happy Paws @ Unleashed of and from any and all responsibility for releasing your dog to any persons Happy Paws @ Unleashed believes to be authorized by you. Please list any special instructions here: Happy Paws @ Unleashed will release your dog to the following person(s) with proper ID: Policies:
Authorized Pick Up. Under no circumstances will the student be released to anyone other than parent/guardian or those listed below without written permission from parent/guardian. Even with written permission, any persons unfamiliar to School will be required to show valid photo identification. Please alert School in advance when anyone listed below will be picking up. Please remember to inform the above-named person(s) that photo ID must be shown before student can be released to them.
Authorized Pick Up. Only those who have been authorized by the parent will be allowed to remove the child from care. If the parent has not notified Learn Along Daycare that he/she will be late for pick up, and We are unable to reach You, We will attempt to contact additional approved contacts (Your backup) for your child. If no one is able to be reached by Learn Along Daycare, Your child(ren) will be referred to local authorities. Substitute Care Arrangements: We will notify parents/guardians as early as possible if care cannot be provided on a given day. It will be the parents' responsibility to obtain substitute care on those days if not provided. Invoices will not be adjusted when substitute care is provided and turned down by parent. Clothing and Supplies: Children are to be neatly groomed and dressed in clean and comfortable clothes when dropped off. The clothes should be weather appropriate for outside activities and play. Socks and shoes should be brought and dropped off with your child.
Authorized Pick Up. Your child will not be allowed to leave the program with any person who is not designated as an Authorized Pick Up on their registration form. Any person picking up a child must be able to show a valid photo ID upon request. Any changes to the Authorized Pick Up list must be submitted in writing.
