NOTE: Please submit this completed form back to us no later than June 1.

Please note: If you have already completed this form for a Kaleidoscope course, you do not need to resubmit it. If there are additional people who are authorized to pick up from KITE, please let us know before the program begins. Thank you!

Pick-up Authorization

Child's First and Last Name:

NOTE: Parent signature required even if parent(s) is/are only person/people authorized to pick up child(ren).

The person (people) authorized to pick up my child(ren) is (are) (include child's parents):

Parents:

Other Authorized Person(s)

Your typed name is considered your signature.

Note: If someone other than a parent/legal guardian will bring your child on the first day, please be sure to complete and sign this form in advance!