Please complete this form only if either of the following applies:

• Someone other than a parent or legal guardian may pick up your child from UCFC activities; or

• Your child has permission to arrive at or leave training independently.

This authorization remains in effect for all sessions your child attends during the 2026-2027 Season unless you notify us in writing of any changes at ucfc.nyc@gmail.com.

IMPORTANT: Independent dismissal is only available for players born in 2010–2016. Players born in 2017-2022 must be picked up by an authorized adult at every session, regardless of this form.

To change or revoke this authorization at any time, email ucfc.nyc@gmail.com with subject line "Dismissal Change – [Player Name]".