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Evacuation Release Form
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Columbia Adventist Academy

Evacuation Form
Must Print Two.


School Year

Child's Name
Teacher 
Child's Home Address
 
Child's Home Phone

In case of an emergency and it is necessary to close the school, my instructions given to my child are as follows:

My child is to walk home when conditions are considered safe.
My child is to be picked up by his/her parents.
My may be released to the following people:
  Name
  Name
  Name
  Name
  Name
     
My child may be released to any responsible adult who offers transportation.

To protect my child, let my child act according to these instructions if possible; otherwise, use your best judgment.

 


Signature

Relationship to Child___________________

Date



         

 



241 Riverchase Way • Lexington, SC, 29072-9470 • 803-796-0277