Burleson Adventist® School

Giving

Student Release & Media Permission

Student Release & Media Permission Form

This field is for validation purposes and should be left unchanged.
Student Name*

Authorization for Release of Student

I hereby authorize BAS to release my child to the following individuals ONLY:
Person #1*
Person #2
Person #3
Person #4
Consent*

After-School Registration

After-school care (ASC) FEES: $10 per child, per hour (charged at the beginning of each hour, e.g. 3:45 – 4:45 = $10; 3:45 – 5:30=$20). ASC Hours: 15 min after dismissal – 5:30 pm. Charges after 5:30 pm = $5 per 15 min.
What days will you need regularly scheduled ASC?
Consent*

Permission to Photograph

I grant permission to photography/video my child for the following reasons. Check ONLY the boxes you grant permission for.
Permission Granted for:
Photography Consent*
Parent/Guardian Name Agreement*