My child(ren) has/have permission to be released to the individuals listed above in the alternate pick-up & emergency contact sections. As is standard in child care programs, if I am past the designated time to pick up my child(ren) I will be charged a late fee of $1 per minute, per child. To the best of my knowledge all of the information provided is accurate. I agree to the terms outlined above. (Please sign and date below.) *