All Aboard at Valhalla, Inc,
400 Columbus Ave
Valhalla, NY 10595
914-741-1500

Release of Confidential Information

Child’s Name: _________________________
Today’s Date: ________________________

I give _______________________________, my child’s therapist permission to contact, visit and release information to the All Aboard Childcare staff.

Parent’s Signature _____________________________________




Therapist’s Name _______________________
Telephone Number ______________________