Child Release Policy

Parents will designate person(s) who will be allowed to pick up their children from Emerson Academy. Children will only be released to the parent/guardian or person(s) designated by the parent. People picking up a child must show proof of identity, and staff will record the identity of those person(s) by photo-copying their means of identification.

First Designated Person

Full Name

Relationship

Second Designated Person

Full Name

Relationship

Third Designated Person

Full Name

Relationship

Fourth Designated Person

Full Name

Relationship

Fifth Designated Person

Full Name

Relationship

Are there any family members that may NOT pick up your child? If so, please print their full name and attach any documentation that you may have, such as a restraining order or court order.

If yes, who?

Parent/Guardian Signature

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Child Release Policy

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