Authorized Pickup Form

The QUENTIN ROAD CHRISTIAN PRESCHOOL has my permission to release my child/children, to the following person(s), on the following date(s), .

Special Instructions:

Please check the following:

This is for the above dates only.

This person has my permission to pick up my child/children at any time.

Date

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Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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Timestamp

Audit

May 19, 2025 1:32 pm CDT

Authorized Pickup Form Uploaded by Quentin Road Christian Preschool - schedule@qrcp.org IP 50.171.8.10

June 2, 2025 2:21 pm CDT

Preschool Office - schedule@qrcp.org added by Quentin Road Christian Preschool - schedule@qrcp.org as a CC'd Recipient Ip: 50.171.8.10