Pick Up Permission Form

 

             Please list any people below that have permission to pick up your child from school. Anyone not on this list, will not be allowed to leave with your child, unless the parent has made other arrangements with me.

 

     Name                                                                                  Phone #

 

1.

 

2.

 

3.

 

4.

 

5.

 

Parent/Guardian Signature ___________________________

 

Date_________________________