TWISPP Authorization for Release Form

TWISPP Authorization for Release Form
Please enter the Access Code provided to fill out the form.*
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Parent/Caregiver Name*

First NameLast Name
Email*
example@example.com
Please list any additional adults (18 years or older) who will be authorized to pick up your child.

Adults who have your authorization and are listed on this release form will need to present a current photo ID to the teacher at time of dismissal.

Please inform us when to expect authorized persons to pick up/drop off your child.
Adult #1:
Name: First Name Last Name. Relationship to Child: blank.
Address: . Phone Number: Area Code Phone Number
Adult #2:
Name: First Name Last Name. Relationship to Child: blank.
Address: . Phone Number: Area Code Phone Number
Adult #3:
Name: First Name Last Name. Relationship to Child: blank.
Address: . Phone Number: Area Code Phone Number
I hereby authorize TWISPP to release my child to the above listed persons.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: