Holiday Release Form

Child Name

First NameLast Name

Child's Class

Class Name

Staff Name

First NameLast Name

Date

Hour MinutesAM/PM Option

Parent/Guardian Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship To Child

Pick point for the child

I, First Name Last Name , understand It is my responsibility to return the child to the designated pick point on Date at Time .

Rules:

1. The children will not smoke or drink any alcohol.
2. The child will not be engaging in any sexual relations.
3. The child will not be abused physically and/or verbally.
4. The child will be fed well.
5. The child will not be taken to a traditional doctor.
6. The child will dress appropriately.
7. The child will not be selling on the street.
8. The child should be back in the home by 18:00.
9. Children bath every day and should be wearing clean clothes.

I agree with the following statements:

Date

Signature