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Banana Splits Release Form Dear Parents, Please print out, complete and mail or drop off this form to Kevin Lee at Town Hall. Or, you can use an email form version by clicking here. Thanks! 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:
ALL INFORMATION IS CONFIDENTIAL.
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PLEASE RETURN THIS COMPLETED FORM TO KEVIN LEE, YOUTH ADVOCATE Location: Room 118, Town Hall, Dartmouth, MA 02747 | 508-910-1855 |