Alternative Pick-up Authorization Form

Alternative Pick-up Authorization Form

Use for individuals not listed on the child's emergency form
Child's Name
Date (s) of Pick up

MonthDayYear
Date
Name of Alternate pick-up
Person must be over 18 years of age
Alternate's Phone
Please alert your alternate pick-up person that your child must be signed out upon pick-up by an Adult 18 years and older.

We will ask your alternate pick-up individual for identification before we release your child/ren.

Please note that students must be picked up by 5:30 PM.
Parent/Guardian Name
Signature

Clear
Date

MonthDayYear
Date
**This form should be submitted electronically or emailed to highhopetifton@gmail.com before 3 PM the day prior to the day in which the alternate pick-up arrangement is needed or as soon as possible. The office will add the form to your child's file.
Should be Empty: