TVBC Eagles' Nest Registration

Special Instructions (if any)
Authorization for additional persons who may pick up child(ren) (ID Required)
Name (authorized person to pick up children)
Phone
Relationship
Name (authorized person to pick up children)
Phone
Relationship
Authorization to self-check out from Eagles' Nest (Grades 10-12 ONLY)
Name (authorized to self-check out)
Phone
Email
example@example.com
Name (authorized to self-check out)
Phone
Email
example@example.com
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
Should be Empty: