Pick-up Authorization Form 2019-2020
This form is to be completed if you have a change in the person/people who will be picking up your child. Please complete this form with as much notice as possible.

If the change is for the day of and it is after 1:00 pm complete the form and email Stacy at stacyf@edcjcc.org

You will find a Pick-up Authorization Form on your campminder accounts under forms. This form is to be completed if there is a consistent person/family that will be picking up your child/children. Please complete that form to have on record.

Child's Name *
Your answer
Second Child's Name (Optional)
Your answer
Third Child's Name (Optional)
Your answer
Date of Pick-Up Change *
MM
/
DD
/
YYYY
Name of Person Picking Up *
Your answer
I give permission to the EDCJCC to Release my child from the After School Program to the above named person. *
Sign Your Name *
Your answer
Comments
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