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    • Home
    • About Amy
      • Meet Amy
      • My Life With Christ
      • Active Your Stem Cells
      • Essential Oils
    • Music Programs
      • Primer Piano, Ages 5-6
      • Elementary Piano, 7-11
      • Teen Piano, Ages 12-18
      • Guitar Lessons, 8-18
      • Ukulele Lessons, 7-18
    • Awesome Songs!
    • Events
      • 2025 Spring Recital
      • 2025 Music Competition
      • 2024 Christmas Recital
      • 2024 Spring Recital
      • 2023 Family Talent Night
      • 2023 Spring Recital
      • 2023 Music Competition
    • Appointments
  • Home
  • About Amy
    • Meet Amy
    • My Life With Christ
    • Active Your Stem Cells
    • Essential Oils
  • Music Programs
    • Primer Piano, Ages 5-6
    • Elementary Piano, 7-11
    • Teen Piano, Ages 12-18
    • Guitar Lessons, 8-18
    • Ukulele Lessons, 7-18
  • Awesome Songs!
  • Events
    • 2025 Spring Recital
    • 2025 Music Competition
    • 2024 Christmas Recital
    • 2024 Spring Recital
    • 2023 Family Talent Night
    • 2023 Spring Recital
    • 2023 Music Competition
  • Appointments

Authorization Form 2024/2025

this form is For anyone other than a parent picking up or dropping off your child regularly

To print, right click and highlight


Child's Name: _______________________________________________


Main pick-up person: 

Name: _____________________________________________________ 

Address: ___________________________________________________ 

Relationship: _______________________________________________ 

Phone: _________________ __________________ 


Person(s) who may pick up child/children on a less frequent basis: 

Name: _____________________________________________________ 

Address: ___________________________________________________ 

Relationship: _______________________________________________ 

Phone: _________________ __________________ 


Name: _____________________________________________________ 

Address: ___________________________________________________

Relationship: _______________________________________________  

Phone: _________________ __________________ 


Any person(s) NOT authorized to pick up my child/children: ___________________________________________________________ 


Note: Any person unfamiliar to me will be required to show proof of identification. Under NO circumstances will the child be released to anyone other than those listed above without WRITTEN permission from the parent or a phone call. 


Mother's Signature: _______________________ Date: ______________ 


Father's Signature: ________________________ Date: _____________

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