MSAS Student Sign-Out Form

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This form must be completed for each student being picked up daily. If you have multiple people authorized for pickup for your student(s), please share this form with them. Do not submit the form until you are at the designated pick up location.

Přihlaste se do Googlu, abyste mohli uložit dosavadní postup. Další informace

E‑mail *

Student Last Name *

Student First Name *

Name of Authorized Person Picking Up Student *

By checking the box below I acknowledge that this form serves as my electronic signature for daily sign-out. If it is determined that the authorized person picking up is not on premises when this form is submitted, the time may be altered by the afterschool site director to match time of pickup and the parent/guardian will be notified. Late charge may be applied. *

Check here to authorize sign-out

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