Authorized Pick Up

Authorized Pick Up

You may enter up to 4 people you authorize to pick up your child. If you do not authorize anyone other than child's parents, you will still complete this form selecting parent only, signing, and submitting.
Child's Name

First NameLast Name
ExplorersExplorers with Early BirdExplorers with Lunch BunchInvestigatorsInvestigators with Early BirdInvestigators with Lunch BunchInvestigators with ResearchersInvestigators with Researchers and Early BirdInvestigators with Researchers and Lunch Bunch
Parent/Guardian's Name

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Can anyone other than the parents pick up your child?
If parents are the only ones who are authorized to pick up the child, please scroll down and submit form.
Pick Up Person 1

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Pick Up Person 2

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Pick Up Person 3

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Pick Up Person 4

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Parent/Guardian Signature

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