Child Permission to Go Home Alone Form
Please complete this form to provide your permission for your child to leave the school, camp, or program and go home alone.
Child's Full Name
*
First Name
Last Name
Program, School, or Camp Name
*
Date Permission Applies
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Grandparent
Other Relative
Other (please specify)
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Signature
*
Submit Permission
Submit Permission
Should be Empty: