ELC Permission to Collect Form
ELC Permission to Collect Form
Parent/Guardian Name
Parent/Guardian Name
*
First
Last
Parent/Guardian Email
*
Number of child/ren for collection
*
1
2
3
Child Name
Child Name
*
First
Last
Child Name
Child Name
*
First
Last
Child Name
Child Name
*
First
Last
Name of person authorised to collect child/ren
Name of person authorised to collect child/ren
*
First
Last
Date of collection
Date of collection
*
/
DD
/
MM
YYYY
Parent/Guardian Signature
I understand that the above named person will be asked for identification if unknown by Centre staff.
Draw your signature into the box below.
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.