Trackside Permission Form

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Please use this form to notify us when you child has your permission to leave Trackside with someone other than a parent/guardian.

Email *

Parent Name and Phone Number *

Trackside Member's Name (Child) *

My child has permission to: *

Leave Trackside on their own (walk, ride bike, etc.)

Leave with another adult

Other:

If you child is to be picked up by another adult, please provide the adult's name

Please provide the date(s) that this permission applies to. If you need to revoke permission for any reason, please send an email to staff@trackside.org *

Verify Permission *

I verify that I am a parent/legal guardian of the above indicated child and that I give my permission for Trackside Teen Center of Wilton to allow my child to leave Trackside's premises in accordance with the above information. I understand that if this changes for any reason, I must notify Trackside by emailing staff@trackside.org or calling 203.834.2888.

Required

A copy of your responses will be emailed to the address you provided.

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This form was created inside of Trackside, Teen Center of Wilton.