The Yellow School Memorial Drive Presbyterian Church 11612 Memorial Drive | Houston, Texas 77024 713-782-0820 | ys.mdpc.org

PERMISSION FORM FOR ESCORT TO REACH CLASSES

An escort is not provided by the Yellow School, but only by willing REACH instructors. This form must be completed for each REACH class at the beginning of each semester.

The top portion must be turned in to Yellow School BEFORE your child will be released from our school.

Child’s Name

Yellow School Class

REACH Class

REACH Semester Fall Spring

Day(s) and Time(s)

Parent’s Name

Address

Phone (Home) (Cell) (Work)

My child has permission to be picked up by the following people to be transported to the REACH class stated above: Parent Signature ________________________________________________ Date __________________

Please tear off the bottom portion. Return the top portion to the Yellow School.

Give the bottom portion to the REACH instructor on the first day of class.

Child’s Name

Yellow School Class

REACH Class

REACH Semester Fall Spring

Day(s) and Time(s)

Parent Signature ________________________________________________ Date __________________