New Page 1

Banana Splits Support Group
Release Form-Via Email

Dear Parents,

To send the Release Form via email please follow these steps:

Copy the entire form below. (How? Left click and scroll over entire Form, then right click, and choose copy)
Next, Click this link > Email Form To Kevin Lee.
Paste the form into the email that will open addressed to Kevin.
After you copy it to your email, complete the form. ☺
When the form is completed, send it to me!

After you send the Form using email, this page reappears. You're done! I will send you a note within a few days indicating that your form has been received. Thank you.

Kevin Lee, Youth Advocate

↓ Copy Form ↓ ↓ Copy Form ↓ ↓ Copy Form ↓

Banana Splits Release Form

We understand that sometimes parents need to assign other trusted adults to drop-off or especially pick-up their child on group day. As a safety precaution, no child will be released to anyone who is not listed on the form below. Please include parents on the list as well. Thank You!

________________________________________________________________________

Child’s Name

The following adults have my permission to pick-up my child following group time:

Adult Name	Address	Phone	Relationship to my child

ALL INFORMATION IS CONFIDENTIAL.

_______________________________________ _________________________
Parent/Guardian Signature Date