AUTHORIZATION TO PICK UP A CHILD FORM

ForeverEvolving Dance We Are Forever Frolving

Name of Child/ren

I hereby inform Forever Evolving Dance Company that the people listed below are authorized to pick up the above named child/ren at any time. Accordingly, FEDC is hereby instructed to release my child/ren into the care of the following people at any time they are present at FEDC. AUTHORIZED PICK-UP PERSON (must be a minimum of 18 years old unless special written arrangements are made

Approved name Relationship to child/ren Phone Number:

1. Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

Parents/guardians must inform the FEDC administration team when the name of the person listed above will pick up their child/ren. This applies when the child's normal pickup routine varies.

Any person that picks up your child/ren may be asked to provide a photo ID to the staff if they are not familiar with the person on the above list. This document shall remain valid until edited or rescinded in writing by the parent/guardian. Authorized by:

Print Date

Date

Signature Date