Drop Off and Pick Up Information Child's Name * First Name Last Name Child's Date of Birth * MM DD YYYY Parent/Guardian's Name First Name Last Name Parent/Guardian's Name First Name Last Name Pick Up Person 1 This person is authorized to pick up my child from The Child Language Center/Wings on Words Program. Photo identification will be required. Pick Up Person 2 This person is authorized to pick up my child from The Child Language Center/Wings on Words Program. Photo identification will be required. Pick Up Person 3 This person is authorized to pick up my child from The Child Language Center/Wings on Words Program. Photo identification will be required. Pick Up Person 4 This person is authorized to pick up my child from The Child Language Center/Wings on Words Program. Photo identification will be required. Pick Up Person 5 This person is authorized to pick up my child from The Child Language Center/Wings on Words Program. Photo identification will be required. I plan to drop off my child at the following time: * I plan to pick up my child at the following time: * Your Printed Name * When printing your name, you are acknowledging the printed name on these documents will act as your temporary authorization and we will require you to sign the documents in person): First Name Last Name E-Signature * Typing your name into the following field acts as your e-signature. Additional in-person signatures may be required. Signature Date * MM DD YYYY Thank you!
