Child Pick-up Authorization Form

PARENTS AND GUARDIANS: Please complete this form for each child you are registering.

  • MM slash DD slash YYYY
  • NO ONE WILL BE PERMITTED TO PICK UP YUR CHILD IF HIS OR HER NAME IS NOT LISTED BELOW. ALL PERSONS MUST HAVE AND SHOW THEIR PICTURE ID WHEN PICKING UP THE CHILD. PLEASE MAKE SURE YOU LIST ALL ADULTS EVEN IF YOU RESIDE IN THE SAME HOUSEHOLD.

  • THE FOLLOWING ADULTS ARE AUTHORIZED TO PICK UP MY CHILD FROM SCHOOL.

  • PERSON(S) OTHER THAN PARENT/GUARDIAN AUTHORIZED TO PICK UP CHILD

  • Section End

  • This field is for validation purposes and should be left unchanged.