Transportation Permission
Last updated: July 2025
Applicant
Student Name
*
First Name
Last Name
Authorized Individuals for Transport from School
Primary Pick-up Person(s)
*
List the first and last names of the primary individual(s) who be picking up your student from school.
Additional Pick-up Person(s)
List the first and last names of all other individuals (if any) who have your permission to pick up your student from school.
Parent/Guardian Consent
By signing my name below, I consent to allow the above individuals to pick up my children from Centerville Christian School. I recognize that this permission will stand unless I revoke it by phone or in person.
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Date
*
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Month
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Day
Year
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