Reach Developmental Preschool Emergency Contact / Pick-up Form

Reach Developmental Preschool is authorized to contact the following individuals in cases of emergency where I am unavailable.

Emergency Contact 1

Name:*
Phone Number:*
Relationship to Child:*

Emergency Contact 2

Name:
Phone Number:
Relationship to Child:

In case of a medical emergency when the parents/legal guardians or alternate emergency contacts cannot be reached, I authorize the Reach Developmental Preschool-South Delta to transport my child, by ambulance, to Delta Hospital.

The following individuals are authorized by me to pick up my child from the Reach Developmental Preschool-South Delta. If, at any time, someone not on this list will be picking up my child, I will advise the preschool in advance at 604-946-6622 ext. 308.

Any individuals listed or not may be asked to produce identification. I understand that the individuals listed below are authorized to pick up my child at any time, with or without notification being provided to the Reach Developmental Preschool on that day.

Mother:
Father:
Other 1:
Other 2:
Other 3:
Other 4:

Parent(s) / Guardian(s) Signature:*

Parent(s) / Guardian(s) Email:*

Date:*

_{Any personal information provided to Reach Child and Youth Development Society is collected and used in accordance with British Columbia’s Personal Information Protection Act (PIPA). For details of our privacy policy, please contact us at 604-946-6622, or email inforeachdevelopment.org.}