After School Travel Arrangement

After School Travel Arrangement Form

Family Name

Child(ren) Names AND Grades (First and Last Name, Grade)

My child(ren) have permission to:

Walk Home

Go to Kid's Club

Will be picked up in carpool by me

Walk to... (include name of person that child(ren) have permission to walk to in next section)

May be picked up in carpool by (include name(s) in following section)

My child(ren) have permission to walk to:

My child(ren) may be picked up in carpool by:

Others who have permission to pick up my child(ren) are:

I undersatnd that my child(ren) cannot be released to anyone else other than those listed, without written notification.

Acknowledgement of statement above.

Parent/Guardian E-Signature

Date

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