Emergency Contact and Pick-Up Form

Emergency Contact and Pick-Up Form

(One form per family/Update as needed)
Parent / Guardian Information (person filling out form)*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please list your student(s) and their respective grade(s) for the upcoming school year.*
Please list all adults (including parents/guardians) who are either an authorized pick-up or emergency contact for your student. All fields must be filled out, and either EC or PC MUST be checked.
EC = Emergency Contact | PU = Authorized Pick-Up.

Adults who are not listed will not be permitted to pick-up your student without prior written written consent.
Emergency Contact / Pick-Up List:*
If applicable, please list anyone who is NEVER permitted to pick up your student(s).
Questions / Comments:
Should be Empty: