Mora High School / Lazaro Garcia Middle School

Mora/Holman Elementary School

Pick up Authorization Form -- School Year 2020-2021
EMERGENCY PHONE NUMBERS AND AUTHORIZATION TO PICK UP YOUR CHILD.
Please list all persons that have your permissiion to pick up Student Name.
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
Signature

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Date

Month Day Year
Date
Should be Empty:

Mora/Holman Elementary School