Authorized Pick-Up Form (The Club House)

Authorized Pick-Up Form (STEAM)

The individuals listed below are authorized to pick-up my child. I acknowledge and understand that the individuals I, the parent/guardian, list below are required to show valid, current, state approved identification prior to Somerset Academy, Inc. releasing my child. I understand that there are no exceptions to this policy.

Child ‘s First Name

Child’s Last Name

Section

Authorized Person #1

Phone Number

Relationship

End Section

Parent/Guardian Signature

Date Signed:

Date Received in Somerset Academy, Inc. Office

Sending

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