Child Pick Up Authorization Form
Which Location does your child attend
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Please Select
Toddler Town Evanston- 1501 Howard Street
Toddler Town Chicago - 5934 W. Diversey
Please enter your 4 digit Door Entrance Code
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Date
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Month
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Day
Year
Date
Child's Name
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First Name
Last Name
Parent's Name
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First Name
Last Name
Parent Email
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example@example.com
Parent's Phone Number
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Please enter a valid phone number where we can contact you with any questions
Format: (000) 000-0000.
Teachers Name
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I am authorizing the person listed below to pick up my child(ren) today. I understand that they are not on my main pick up list and am adding them here today.
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First Name
Last Name
Pick Up Person's Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Pick up Person's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Signature - I will let the pick up person know that they are required to bring a State issued photo ID with their name on it and I will let them know that they have to arrive at the center by 5pm or that there will be late fees associated with a late pick up.
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Submit
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