Early Student Pick-Up Form

1
Identify YourselfPlease note that we will not release your child to an adult that is not authorized to pick them up. If there is an adult coming to pick up your child that is NOT listed in Teacherease, please provide us with their Full Name, Phone Number and their relationship to the student so we may add them as one of your child's Emergency Contacts. All adults picking up a student must have valid photo ID.
Parent/Guardian
Authorized Adult or Emergency Contact
2
Parent/Guardian Picking Up Name* This field is required.All adults picking up a student must have valid photo ID.
First Name
Last Name
3
Parent/Guardian Email* This field is required.
example@example.com
4
Student Name* This field is required.
First Name
Last Name
5
Student Cohort* This field is required.
Please Select
Please Select
601
602
603
604
701
702
703
704
801
802
803
804
6
Date & Time of Early Pick Up* This field is required.Please note early pick up is highly discouraged during the lunch period (12:00pm-12:45pm) or during the last 30 minutes of the school day (after 2:00pm) as this may cause delays and we cannot guarantee a timely dismissal.
Date
Month
Day
Year
2
1
2
3
4
5
6
7
8
9
10
11
12
Hour
05
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
PM
AM
PM
7
Is this early dismissal based on recommendation by the school nurse?* This field is required.This is used to identify students who are being picked up due to illness and for appropriate follow up.
YESNO
8
Does your student have a cell phone or other smart device?* This field is required.This is used to identify if a student’s device needs to be held in the main office for a speedier release
YESNO
Should be Empty: