Preschool Guardianship Permission Form

Child Information

Child's Full Name

Date of Birth

Class/Room

Parent/Guardian Information

Parent/Guardian Name

Relationship to Child

Contact Number

Email Address

Authorized Person for Pick-up

Authorized Person's Name

Relationship to Child

Contact Number

Permission Details

Details / Special Instructions

Agreement

I, the undersigned parent/legal guardian, authorize the above-named person to pick up my child from preschool as specified.

Parent/Guardian Signature

Date