GHH Visitor & PickUp Permission Authorization
Please note that only the enrolling Parent/Guardian will be permitted to complete this form
Date:
Child’s Name:
Parent/Guardian:
Cell Phone:
Agency:
Caseworker:
Caseworker Email
Caseworker CellPhone
Authorized Visitor & Pick Up Release - Please list any individual who is authorized to pick up or visit your child, including yourself. Each authorized person must be at least 21 years of age. The above-named child will not be permitted to leave the program with anyone who is not listed below. Authorized individuals will be requested to show identification to program staff. Visitors cannot be same-age friends or acquaintances. Visitors must be a Caseworker, Therapist or Professional with knowledge of the child. Children will not be released to persons who fail to provide acceptable identification upon request. Please list the responsible persons with permission to pick up or visit your child from the program.
*Visitors must notify the Camp Director 12-24 hours in advance that their presence is expected. Camp activities will be in process and staff will need to make arrangements to ensure the child can be available.
Parent or Guardian Name*:
Signature of Parent or Guardian:
FOSTERING NEW BEGINNERS