2021-2022 School Year Parent Pick Up
Please fill out this form if your child(ren) will be a parent pickup this school year.  If you have multiple students to pick up, you only need to fill out this form ONCE. Be sure to include the additional student names in the appropriate area below.
After submitting this form, any changes to this information will need to be submitted in writing to the main office. Please call us with any questions about this form or how to make changes: (757) 886-7961.
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Student Last Name *
Student First Name *
SIBLINGS - Please list the first and last names of any other siblings/students you will be picking up so we can provide you one pickup number. (i.e. Rose Smith. If not applicable, put N/A.) *
Primary Parent's First Name *
Primary Parent's Last Name *
Primary Parent's Email
Primary Parent's Phone Number *
Alternate Phone Number for Primary Parent *
Please list any authorized person/s that will be allowed to pick up the student/s. Include first and last name, relationship, and phone number. (i.e. John Smith - Father- (555)555-5555) *
I understand that I, or any of the authorized persons listed above, must have my pickup number with me DAILY in order to pick up my student/s.  Otherwise, I must park and bring my ID to the main office to pick up my student/s. **PLEASE NOTE: STUDENTS WILL NOT BE ALLOWED TO BE DISMISSED 30 MINUTES PRIOR TO OUR DISMISSAL TIME** *
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