Child Release Form printable pdf download

Calvary Christian School – Child Release Form

To further ensure the safety of our students please fill out this form. If any of the provided names or

contact information need to be changed at any time during the year, please notify the school office

immediately.

Student Name:_________________________________________ Grade:_________________

Parent/Guardian Name:_________________________________________________________

Mailing Address:_______________________________________________________________

(Street or PO Box)

City:____________________________________ State:________ Zip Code:_______________

Home #:__________________________________

Mother/Guardian Cell #:__________________Work #:__________________

Father/Guardian Cell #:___________________Work #:__________________

Emergency Contact Persons (other than you or your spouse):

Name:_________________________________Relationship:___________________________

Home #:___________________Cell #:__________________Work #:____________________

Name:_________________________________Relationship:___________________________

Home #:___________________Cell #:__________________Work #:____________________

Your child will ONLY be released to the people you name below who CAN pick up your child from

school. Anyone who tries to pick up your child whose name is not listed below as having permission, will

be asked to present a photo ID and you will be contacted to verify whether it is okay to release your child

to them. Please write the full name of each person you list below.

Who CAN pick up your child from school? (If you are having someone pick up your child during the school

year who is not on this list, please call the school office ahead of time to let us know and we will add them.

Please also list your emergency contact persons here as well.):________________________________________

__________________________________________________________________________________________

***We are legally required to release students to their parents. However, if you have a situation where

one parent or other individual is not LEGALLY allowed to pick up a child BY ORDER OF THE

COURT, please list below that person’s full name, briefly explain the situation and provide the legal

documentation with this Child Release Form at enrollment. Please do not write any names here unless you

can also provide the required legal documentation.________________________________________________

__________________________________________________________________________________________

Child Release Form