Authorization to Pick Up a Child Form

Beth Shalom Religious School Authorization to Pick Up a Child Form

This form informs the Beth Shalom Religious School what individuals are authorized to pick up your child. This form must be completed by a parent or legal guardian. It will be applicable throughout the current school year. If you need to make any changes, temporary or permanent, to this information, you must contact the Religious School ahead of time. Please complete one form for each child attending the Religious School.
Parent/Child Information
Today's Date

MonthDayYear
Date
Parent Completing this Form

First NameLast Name
Parent Email
example@example.com
Parent Cell
Please enter a valid phone number.
Child

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade
Child Pick-up Authorization

I give permission for the Beth Shalom Religious School to release my child to the people listed below. I understand that the Beth Shalom Religious School staff may require these people to furnish photo ID before releasing my child.
List of Authorized Pick-up Persons
If there is any information or situations that we need to be aware of, please indicate below.
By signing below, I understand and agree to the above.

Clear
Date

MonthDayYear
Date Signed
Should be Empty: