Complete this form when 1) Children are released from the care of the center to participate in activities unsuprevised by the family day care provider. 2) Children arrive or depart the center by means other than parent or guardian provided transportation. (Example: School bus or child care provided transportation to and from school.)
_________________________________________________________________________________________
My child, _____________________________, will arrive at Linn Street Child Care Center
from __________________________________ by way of ____________________________________
at _______________ am pm on the days circled below.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
_________________________________________________________________________________________
Allow my child, _____________________________, to leave Linn Street Child Care Center
to go to _____________________________________ at ___________ am pm
on the days circled below by the following means
________________________________________________________________
(type or transportation and responsible party)
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Additional instructions
I understand that I am responsible for notifying the center of any changes in this schedule, such as vacation and school conference days.
Signature-parent:______________________________________________
Date signed: _____________________________
Note: Please advise me of school cancellations and early dismissals with as much advanced notice as possible so that I can make arrangements if necessary.
Thank you!
Sheri