Strickland Christian School – Pick-Up Authorization Form (2026–2027)
Authorize who may pick up your child(ren) for the 2026–2027 school year.
Student Pick-Up Information
Child 1 – Pick-Up Information
Child’s Full Name
Grade
Pick-Up Time
12:00
3:00
Later
Child 2 – Pick-Up Information
Child’s Full Name
Grade
Pick-Up Time
12:00
3:00
Later
Child 3 – Pick-Up Information
Child’s Full Name
Grade
Pick-Up Time
12:00
3:00
Later
If being picked up later than 3pm, please specify time
Authorized Pick-Up Individuals
In addition to parents, only the following authorized individuals are permitted to pick up my child from school:
Authorized Individual 1
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Authorized Individual 2
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Authorized Individual 3
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Authorized Individual 4
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Authorized Individual 5
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Authorized Individual 6
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Authorized Individual 7
Name
Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship
Custody & Family Information
If you are divorced, we must know who has custody of your child. Please also indicate if any parent is not permitted to pick up your child. Please provide any additional information that may be beneficial for your child’s teacher to know regarding your family circumstance.
Additional Information (You may include any other information you wish the school to know.)
Parent/Guardian Verification
Mother’s Name
Father’s Name
Printed Name
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: