New City Neighbors Pick Up Authorization Form

In order for your child to be picked up by anyone or walk home on their own, we need to have authorization from a parent or guardian.
  • I give permission for my child(ren) to be picked up by the following people:
    Name (First and last)Relationship to child(ren)Phone number 
  • I give my child(ren) permission to walk home at the end of the program each day.
  • By entering your name you are authorizing what you stated above concerning pick up authorization and permission to walk home.