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SPA Pickup Authorization

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Participant:
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  • For children at least 11 years old by September 1, 2018, please complete Section I
  • For children 10 years old or younger as of September 1, 2018, please complete Section II.
Section I

My child is at least 11 years old as of Sept. 1, 2018

Section II

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: