Student Release Form - Ycusd printable pdf download

Student Release Form - Ycusd

Yuba City Unified School District (YCUSD)

Lincrest Elementary School Extended Day Program

Student Release Form

My child has my permission to:

 Walk home ____

 Ride her/his bike home: ____

My child will leave:

 At the end of the program: ____

 Specify other release time: ___________

(check reason for early release

below)

My child will be leaving prior to the end of the program for the following

reason

(please check one)

____ My child attends a parallel program

(programs in the community

such as organized sports, scouts, youth group activities, private

music or dance lessons)

____ Our family schedule makes it difficult for my child to be picked

up at end of program

____ My child has other non-program obligations

____ Due to Time Change

(from Daylight Savings to Standard Time: students who

walk or ride bikes home will be released at least 30 minutes before dark)

_________________________

______

Student’s name:

Student ID#

______

________________

Grade level:

Home Phone:

Parent/Guardian Name: ____________________________

Parent/Guardian Signature: ____________________________

Date: _____________________

Revised - October 23, 2007

Student Release Form - Ycusd