I/We hereby authorize the people listed in this form to pick up the child(ren) named below from Park Avenue Methodist Day School. This list will be shared with PAMDS staff. Please include the contact information for Parent 1 and Parent 2 (if applicable). Any person on this list can pick-up my/our child(ren) at any time.

NOTE: Due to COVID-19, PAMDS must limit the number of people entering the building. Each child at PAMDS is allowed only 3 Authorized Pick-Up adults for pick-up and drop-off. Only these 3 individuals will be permitted to enter the building. Please list your chosen 3 Authorized Pick-up adults below (again, please be sure to list parents who will be doing pick-up and drop-off on this list). For the health and wellbeing of our community, it is suggested that the adults on the Authorized Pick-Up list are not of vulnerable populations (65 years +, underlying health conditions, etc.).

I understand that:
• As required by the Department of Health, the adult who drops my/our child(ren) off at school in the morning and picks up at dismissal must sign the daily sign-in chart.
• The adult dropping off and picking up my/our children must participate in a daily Health Check.
• The “Authorized Pick-Up Person” must be at least 18 years old.
• This authorization shall remain in force until edited or rescinded by the signer of this authorization.