Menu

MYE Pickup Authorization

Javascript disabled! Please click to return to your registration forms

Javascript disabled! Please click to return to your registration forms

Participant:
Return to Form List

This form is for children 10 years old or younger as of September 1, 2019. You can add additional authorized persons (up to 5 total) as needed, at any time. If an emergency arises where none of your previously authorized persons are available to pick up your child, but you can add an additional person at least an hour before class begins, please do so using this form. After that (or if you are otherwise unable to add a person to this form), contact the program coordinator by phone at 734.936-2660.

My child is 10 years old or younger as of Sept. 1, 2018

Please list any individual who is authorized to pick up your child, including yourself. Each authorized person must be at least 16 years of age. The Participant will not be permitted to leave the Program with anyone who is not listed below. Authorized individuals must pick up children in person and may be requested to show identification to Program staff when picking up a Participant. Participants will not be released to persons who fail to provide acceptable identification upon request.

I authorize the following responsible person(s) to pick up my child from the aforementioned Program activities:

The following individuals are not permitted to pick up my child: