Edit Authorized Representative for School Employees & Families
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Date
Parent/Guardian Name
Child Name
Authorized Person 1 Name
Authorized Person 1 Relation
Authorized Person 1 Age
Authorized Person 2 Name
Authorized Person 2 Relation
Authorized Person 2 Age
Signature of Parent / Guardian
Signature of Witness
Date
Authorized Representative for Employees
2020-2021 School Year
_____________________ (Date)

I, _______________________________(Parent/Guardian), do hereby give my permission to the undersigned Tuscaloosa City School employees to act as my authorized representative on behalf of my child, _______________________________(Child's Name), in my absence. Furthermore, I authorize the undersigned employees to sign any necessary documents, to read and complete any information statements required, and to advise the necessary persons on any conditions which would help my child in receiving services. Information given to the persons signed below and signature made by them will have the same effect as if I had personally received the information and signed my name to any documents

Persons authorized to act as my representative and sign papers on my behalf:

_______________________________ (Name)

_______________________________ (Relationship to above Named)

_______________________________ (Age)

_______________________________ (Name)

_______________________________ (Relationship to above Named)

_______________________________ (Age)

_______________________________ (Signature of parent/guardian)
_______________________________ (Signature of witness)
_________________ (Date)