SY 17-18 PICK-UP AUTHORIZATION
Please provide the name and contact information for one or more adults authorized to pick up your child/children other than a parent or guardian. If you have any questions about this form, you may contact The Children Guild's front office at enroll@tcgdc.org or (202) 774-5442. The Children's Guild DC PCS agrees that all the information below will be kept confidential and will be used only for legitimate TCGDC PCS purposes.
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student 2 Last Name *
Your answer
Student 2 First Name *
Your answer
Student 3 Last Name *
Your answer
Student 3 First Name *
Your answer
Student 4 Last Name *
Your answer
Student 4 First Name *
Your answer
Authorized Person 1 (not parent/guardian): First and Last Name *
Your answer
Authorized Person 1: Relationship *
Your answer
Authorized Person 1: Phone Number *
Your answer
Authorized Person 2 (not parent/guardian): First and Last Name *
Your answer
Authorized Person 2: Relationship *
Your answer
Authorized Person 2: Phone Number *
Your answer
Authorized Person 3 (not parent/guardian): First and Last Name
Your answer
Authorized Person 3: Relationship
Your answer
Authorized Person 3: Phone Number
Your answer
SIGNATURE
Please enter your name and today's date in the boxes below to verify that all the information above is up to date and correct to the best of your knowledge.
Last Name *
Your answer
First Name *
Your answer
Email
Your answer
Today's Date *
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