Whitehall Nursery School Permission for Release of Children

The following is a list of people who may pick up   ________________________________________________
                                                                                                                    (Child’s Name)

Please list anyone who you think would possibly pick up your child from Nursery School.  Your child will only be released to the people you have named below.  NO EXCEPTIONS!

Please PRINT clearly.

                    Name				       Phone Number			               Relationship

__________________________		___________________		________________________

__________________________		___________________		________________________

__________________________		___________________		________________________

__________________________		___________________		________________________

__________________________		___________________		________________________

The following is a list of people who may not pick up my child.  Please advise us of any custodial alerts.

                    Name				    Phone Number			          Relationship

_________________________		___________________		________________________

_________________________		___________________		________________________

_________________________		___________________		________________________

_________________________		___________________		________________________

                                                                                          _____________________________________________
                                                                                    (Signature of Parent or Legal Guardian)

*PHONE CALLS SAYING THAT A CHILD MAY LEAVE WITH SOMEONE WILL NOT BE ACCEPTED!  PLEASE BE SURE TO GIVE ANYONE ON YOUR LIST THAT MAY BE PICKING UP YOUR CHILD AN IDENTIFICATION CARD.  THESE ARE PROVIDED BY THE NURSERY SCHOOL AND WILL NEED TO BE SHOWN TO THE TEACHER WHEN THEY COME TO PICK UP YOU CHILD.  WITHOUT THIS CARD, THE CHILD CANNOT BE RELEASED TO THAT PERSON.  THIS IS FOR YOUR CHILD’S SAFETY!