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PICK UP AUTHORIZATION

Pick up is at 5pm. Please fill out one form for each child.

Student's Full Name (first & last)

Parent/Guardian's Full Name (first & last)

Parent/Guardian Email

Parent/Guardian Phone

List ALL individuals, including primary parents or guardians, who will have permission to pick your child up from the HELP: GRACE - Millen Afterschool Program. Students will not be allowed to leave with anyone not on this list unless there is written consent from the primary parent or guardian of the child.

Please choose one of the following options:

If you have chosen the bus option above, please give us the physical address your child will need to be dropped off at

Global Relief Association for Crises and Emergencies

Email: info@globalreliefassociation.com

Mailing Address:

PO Box 677

Millen | Ga | 30442

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