Child Pick-Up/Release Authorization Form

Trinity Preschool of Berwyn takes the safety of our students very seriously. We will never release any student to be picked up by anyone not expressly authorized to do so. Please use this form to list anyone who is permitted to pick up your child(ren) and drive them from school.

Please Note: In case of an early dismissal or emergency closing, these contacts will be notified to pick up your child if a parent or guardian cannot be reached.

Child Pick-Up/Release Authorization

Parent's Name*
Name of parent completing this form.
First Last
Name(s) of enrolled Trinity student(s)*
One child per line. Press + to add additional children.
Persons Authorized to Pick Up Student(s) From School
Please list all authorized persons who may pick up your child(ren) from Trinity Preschool. One person per line. Press + to add additional people.
Full Name Home Telephone Cell Phone Relationship
Consent*
By submitting this form, I agree that the persons named on this form have my permission to have my child(ren) released to them and to drive them from school. Permission additions must be done in writing. I also understand that in the case of an early dismissal or emergency closing, these contacts will be notified to pick up my child(ren) if a parent or guardian cannot be reached.

Full Name	Home Telephone	Cell Phone	Relationship

Child Pick-Up/Release Authorization

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