Transportation Permissions

Alternate Pick-Up Authorization

If you want to grant permission in a special case for your child to be released to another adult, please submit this form no later than 1:30 on the day in question.
Your Name (Parent)*

First NameLast Name
Email*
example@example.com
Phone number where you can be reached if we have a question.*

Area CodePhone Number
Is this a one-time request or standing arrangement?*

One-timeStanding
On what day do you want to release your child(ren) to another person for pickup?

MonthDayYear
Date
For a standing arrangement, for which school year are you granting permission to release your child(ren) to another person for pickup?

Please list the students you wish to release to another person? (If multiple children will be released to the same person, then you can check "Same as above" after filling in the person's name the first time.)

	Student First Name	Student Last Name	Level	Release To First Name	Release to Last Name	Same as above
1
2
3
4
5
6

By signing below, I authorize Greenhouse to release the child(ren) listed above to the person(s) listed above for the date(s) specified.
Should be Empty:

Alternate Pick-Up Authorization