STUDENT PICK-UP AUTHORIZATION FORM
THIS FORM IS FOR PERMANENT DAILY PARENT PICK UP ONLY!!!  THIS WILL STAY ON FILE FOR ONE SCHOOL YEAR.  

No one will be permitted to pick up your child if their name is not listed on this form.  All persons must have and show their picture ID if assigned carpool sign is not posted in the car.  Any person unfamiliar to the school will be required to show proof of identification. Under NO circumstances will a child be released to anyone other than those listed on this form without WRITTEN permission from the parent.  In the case of a last minute change or addition, please send a note in the morning authorizing your child/children's release to the new person and including the dates for which permission is given.  Email authorization will be accepted from a parent/guardian's email address that is on file with the school.
Students Name and Homeroom
The following adults are authorized to pick up my child/children from school:   Name and Phone Number *
Person (s) other than parent/guardian authorized to pick up the child:  Name, Phone Number and Relationship *
Person (s) other than parent/guardian authorized to pick up the child:  Name, Phone Number and Relationship *
Person (s) other than parent/guardian authorized to pick up the child:  Name, Phone Number and Relationship *
Please type your name, phone number and date as authorization. *
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