Lunch Release Form

I hereby give…
Child's Name*
First Last
…permission to leave School of the Performing Arts Program at Proctors Collaborative during the lunch break.

It is understood and agreed that when my child checks out of the program, they are not within the protective custody of Proctors Collaborative. The Proctors Collaborative staff is not responsible for the supervision, safety, and custody of my child during this period of time.
Parent's Name*
First Last
Electronic Signature By typing your name below and hitting Submit, you are agreeing to the above.
Parent's Email*
Signature*
First Last
Date*
MM slash DD slash YYYY

Dear patrons: