Forms: Transportation Plan

Transportation Plan and Off-Site Authorization



Persons other than parent picking up and/or dropping off:

Authorized to pick up / drop off
Authorized to pick up / drop off
Authorized to pick up / drop off

Written notice from Parent/Guardian must be given to MOM prior to someone other than those listed on this form can pick up. MOM Staff reserve the right to not release any child to an unauthorized pick up person. MOM Staff may ask for Identification upon releasing a student to someone other than his/her parent.

Off-site Permission

Name of Educator(s) responsible for child: Staff of M.O.M.

Name of off-site location and address:
Pappas Recreational Fields and Playground
203 Pakachoag Street
Auburn, MA 01501

Date of off-site activity: daily

Method of Transportation: walk

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By entering my name above, I confirm that all the information entered is accurate and correct as of this date. This permisson will be considered valid for one year.