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
If Checking Out, will student return before end of the day?
Reason for Tardy / Leaving School Early
Today's Date & Time
Are You the Parent/Guardian of the Student?
Parent / Guardian Name
Parent / Guardian Name

First NameLast Name
Are you in the Student's Emergency / Pickup Contact List?
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.Format: (000) 000-0000.
If Other, Please Specify
Relationship to Student
Signature
Should be Empty: