Evacuation Release Form (please print two)

School Year

Child's Name
Teacher
Child's Home Address
Child's Home Phone

---

In case of an emergency and it is necessary to close the school, my instructions given to my child are as follows:

	My child is to walk home when conditions are considered safe.
	My child is to be picked up by his/her parents.
	My may be released to the following people:
	Name
	Name
	Name
	Name
	Name
	Name
	My child may be released to any responsible adult who offers transportation.

 

To protect my child, let my child act according to these instructions if possible; otherwise, use your best judgment.

 

Signature

Date

Relationship to Child  

 

---

Home · History · Curriculum · Staff · Handbook · Calendar · Class Pages · Links · Contact Us