Language
English (US)
Chinese
Breakthru® Pick-up Authorization Form
rel 2024
Authorization to Pick-Up Child
Name of Child
*
As per I.C. / Passport
Name of Parent / Caregiver
*
As per I.C. / Passport
Parent / Caregiver's Contact Number
*
Email
example@example.com
Name of Authorized Person
*
Photo of Authorized Person
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Contact Number of Authorized Person
*
NRIC / Passport No. of Authorized Person
*
Relationship with Child
Grandparents
Relatives / Cousins
Friends
Driver
Other
Vehicle Number
if applicable
Remarks (If Any)
I hereby authorize the above person to fetch my child:
*
Yes, kindly release my child to the above person. Thank you.
Parent / Caregiver's Name
Signature of Parent / Caregiver
*
Submit
Should be Empty: