Your Name (Parent)

Student Information

Authorized Adults

Please list adults who are authorized to pick up your child(ren) from Extended Day.

Please notify Extended Day when someone other than those listed are given permission to pick up your child (i.e. sleep over, athletic event) from Extended Day. 



I have read the information pertinent to the Porter-Gaud Extended Day program and accept that the program is subject to the rules and regulations of the School.​