Pick Up Authorization
Please provide us the name and contact information for the approved individual who will be picking up your student(s). This form is to be used for any instance when the parent/guardian is not picking up the student(s).
Name of approved individual who can pick up your student(s).
Phone Number of Approved Individual
Please enter a valid phone number.
Date that this approved individual will be picking up my student(s).
Is this approved individual permitted to pick up your student(s) at any date/time in the future?
Yes, this approved individual has my blanket permission to pick up at any date/time for the remainder of this school year.
No, I will inform the school when any additional approved pick-ups will be authorized.
Please list student(s) names.
Should be Empty: