NSES Every Day Pick-Up Authorization

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Please complete the form below indicating those individuals that have permission to pick your child up from school each day. (While carpooling helps families and limits congestion, we recommend that you only carpool with those families that you have already been in close contact with to limit potential exposures.)

This form should be completed separately for each child enrolled at NSES who will be every day pick-up. We ask that the form be completed no later than Wednesday, September 1st. (Tags will be available for pick-up on our orientation date, Friday, September 3rd.)

Email *

Student Name (Last, First) *

Student Grade *

Parent/Guardian Name (Last, First) *

Will the parent/guardian be the primary individual picking up your student every day? *

Yes

If not the parent/guardian, please list the full legal name of the primary individual who has your permission to pick your child up from school. (Last Name, First Name)

Please list the full legal name of (1) additional individual who has permission to pick up your student.

Please list the full legal name of (2) additional individual who has permission to pick up your student.

Please list the names of any siblings and/or other students who your child will be carpooling with in the afternoons for pick-up. (This information will be used to group students for a more efficient dismissal process.)

Please provide any other pertinent information regarding student pick-up authorization. (For example, are there any legal documents that the school should be aware of and/or reference when planning?)

Send me a copy of my responses.

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