________________________________ HAS MY PERMISSION

TO PICK UP MY CHILD ________________________________

ON _______________________.

I UNDERSTAND THAT BASC STAFF WILL ASK AND NEED TO

VERIFY THIS PERSON’S IDENTITY AT THE TIME OF PICK UP

AND WILL NOT RELEASE MY CHILD UNLESS THIS CAN BE

CONFIRMED. I HAVE INFORMED THE PERSON WHO WILL

BE PICKING UP MY CHILD TO HAVE VALID PHOTO

IDENTIFICATION AT THE TIME OF PICK UP.

IF NECESSARY I CAN BE REACHED AT THE FOLLOWING

TELEPHONE NUMBER: ______________________.

DATE: ________________________

PARENT SIGNATURE _____________________________________

PARENT PRINT NAME ____________________________________