Authorization to Visit/Take Students Off Campus
Please complete this form if any person other than the custodial parent(s) or guardian(s) may visit your child or take your child off campus - this includes those who may help move a student out at the end of the Academy, or may pick up a child in case of emergency.
Student's First Name *
Student's Last Name *
Which JBA Session is your child attending? *
The following people have permission to visit and/or take your my child off campus:
Person 1:
Person 1 phone number:
Person's 1's relation to your child:
Person 2:
Person 2 phone number:
Person 2's relation to your child:
Person 3:
Person 3 phone number:
Person 3's relation to your child:
The following people do NOT have permission to visit and/or take my child off campus:
Person 1:
Person 1 phone number:
Person 1's relation to your child:
Person 2:
Person 2 phone number:
Person 2's relation to your child:
Person 3:
Person 3 phone number:
Person 3's relation to your child:
Comments:
E-Signature
Please write your name below to verify the above information
Full Name: *
Submit
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