Circle of Friends

Circle of Friends

Pick-up and Drop-off Form
Parent/Guardian Name

First NameLast Name
Child's Name

First NameLast Name
How will your child get to programming?

Someone will drop them offThey will get there on their own (walk, bike, etc.)Other
How will your child leave programming? (If after 7pm, your child MUST be picked up)

Someone will pick them upThey will leave on their own (walk, bike, etc.)Other
Today's Date

MonthDayYear
Date
Signature

Clear

Authorization for pick-up

Please fill out the portion below for authorization of pick-up by someone other than parent/guardian.
I First Name Last Nameam the parent/guardian of the child First Name Last Name .
I hereby inform Circle of Friends that the people listed below are authorized to pick up the above named child at any time. Accordingly, Circle of Friends is hereby instructed to release my child into the care of the following people.

AUTHORIZED PICK-UP PERSON(S)
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Today's Date

MonthDayYear
Date
By signing this form, I give authorization for the above names to pick up my child from the Circle of Friends program.

Clear

Permission for youth to walk or ride bike home

Please fill out the portion below if your child will be walking or riding his/her bike home.
I First Name Last Nameam the parent/guardian of the child First Name Last Name .
I hearby grant permission for my child to leave Circle of Friends progam in order walk or ride his/her bike home. I understand that my child will be walking or riding his/her bike home unsupervised and it will be my responsibilitly once my child has left the Circle of Friends program.
Date

MonthDayYear
Date
Signature

Clear
Please add any additional information for youth pick up and drop off
Should be Empty:

Authorization for pick-up