Please provide the following information for your student attending an after school extracurricular activity at Center School.  The information required is to ensure safety of the students during the class time and dismissal process.  Parents will be required to sign out their children at the end of the class.  If you intend to have someone other than a parent/guardian pick up your child this session, please add their name(s) in the authorized pick up field.  If a person not on the authorized list arrives to pick up a student, or no one arrives to pick up a student, the instructor will call the parent on the emergency phone number provided.

If, for any reason, during the session you will have an adult not noted on this form pick up your child you will be required to send a Note From Home into school with your child on that day with that adults name and contact information.