Millfield Road
Chapel Haddlesey
Selby
YO8 8QF
Dear Parents & Carers
Permission to take home from school

Please complete the form below with the details of any person or persons who are authorised by you to collect your child from school, either at the end of the normal school day or the end of a club or school visit. 

Please note that you will be telephoned immediately if any person that is either not on your list of contacts or is unable to provide a password, arrives at school to collect your child.  In the case of such an event taking place, your child will not be allowed to leave school until this matter is resolved satisfactorily with you.

Full Name        

Relationship to Child

Chosen Password

(Example) Joseph Banks

(eg) Grandfather, Family Friend

 Panda

I ………………………………………………(name) allow the above person or person(s) to collect my child from School

My child ………………………………………... is in Class ……..

I understand that if my circumstances change, it is my responsibility to contact the school office to either add or remove persons to/from this list