Check In / Check Out Form

Check In / Check Out Form

NOTE: All Fields Required
Student's Name*

First NameLast Name
Student's Name*
Grade Level*
Check InCheck Out
If Checking Out, will student return before end of the day?

YesNo
Reason for Tardy / Leaving School Early*
Today's Date & Time*
Are You the Parent/Guardian of the Student?*

YesNo
Parent / Guardian Name*
Parent / Guardian Name*

First NameLast Name
Are you in the Student's Emergency / Pickup Contact List?*

YesNo
NOTE: Only Parents/Guardians or persons listed as an Emergency / Pickup Contact are authorized to Check Out a student. Please see the student's teacher if you are not in the list.
Name of Person Checking Out Student*
Name of Person Checking In Student*

First NameLast Name
Name of Person Checking Out Student*

First NameLast Name
Relationship to Student*
Phone Number*
Please enter a valid phone number.
If Other, Please Specify
Relationship to Student*
Signature*

Clear
Should be Empty: