2019-20 PARENTAL CONSENT FOR DISMISSAL OF STUDENT - MILNES SCHOOL
If your child will be picked up by an outside organization such as the Albright Academy, from Milnes School at the end of the school day, you must provide us with your written consent to release.
By signing this authorization form, I hereby understand that my consent for Milnes School Staff to release my student to the designated party will remain in effect for the CURRENT school year, unless and until a subsequent authorization form is completed, signed and received by MILNES, or a written revocation of this authorization form is received by MILNES, whichever occurs first. I further understand that MILNES reserves the right to request photographic identification for any or all persons who may attempt to pick-up the said Student(s) from MILNES, for the health and safety of the student.
Student LAST Name (1 STUDENT PER FORM) *
Your answer
Student FIRST Name (1 STUDENT PER FORM) *
Your answer
Name of Organization / Caregiver (i.e. All Bright Academy, JCC, Nanny): *
Your answer
Organization / Caregiver Address *
Your answer
Organization / Caregiver Contact Phone Number: *
Your answer
Organization / Caregiver Contact Phone Number: *
Your answer
Parent/Guardian FIRST Name *
Your answer
Parent/Guardian LAST Name *
Your answer
Parent/Guardian email address *
Your answer
Parent/Guardian contact phone *
Your answer
I, the parent/guardian of the student indicated above, hereby authorize Milnes Elementary School (“MILNES”) to release the said student(s) from school, at the approved school dismissal time as set forth by the Fair Lawn Public Schools, to the individual/organization as noted above:
Parent/Guardian initials *
Your answer
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