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ELC Release Form

45 Puddingstone Lane
Newton, MA  02459
617-527-0045 x110

Person 1

Person 2

Person 3

Person 4

Person 5

I give my permission for my child to be released from the program to the people listed above. These names will be listed on our "Release To" sheet. Please note: Changes to this list must be done in writing.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

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