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Pick Up Release Form
6114 Fishburg Road
Huber Heights, OH 45424
Phone: 937-965-7929
firststepsofficestaff@gmail.com
firststepsfcchh.org
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* Indicates required question
Email
*
Your email
Child's Name
*
Your answer
The person picking up your child from school must:
-Display the assigned pick up car number in a vehicle window
-Must be 18 years of age or older
1st Parent/Guardian:
*
Your answer
2nd Parent/Guardian:
Your answer
3rd person I give consent for my child to be released to:
Your answer
4th person I give consent for my child to be released to:
Your answer
5th person I give consent for my child to be released to:
Your answer
DO NOT release my child to the following individual(s). A copy of court orders is required for custodial situations.
Your answer
E-Signature: By entering my name below, I confirm that I filled out the information above.
Your answer
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