EDUCARE AFTER SCHOOL PICK UP St. Helen's School 1801 Union Street - Niskayuna, NY 12309 (518) 382-8225
The following people have my permission to pick up my son/daughter in the event that I cannot. I WILL NOTIFY THE SCHOOL, IN WRITING, PRIOR TO DIMISSAL.
Name:			Relationship:			Phone:
Name:			Relationship:			Phone:
Name:			Relationship:			Phone:
Name:			Relationship:			Phone:
Name:			Relationship:			Phone:
Name:			Relationship:			Phone:
____________________________________________ Parent/Guardian Signature			____________________________________________ Date