Pick-Up Authorization Form

Child’s Name

First Name

Last Name

I authorize the people listed below to pick up my child(ren) from school.

Full Name

Relationship

Work Phone

Mobile Phone

Address

City, State, Zip

Full Name

Relationship

Work Phone

Mobile Phone

Address

City, State, Zip

Full Name

Relationship

Work Phone

Mobile Phone

Address

City, State, Zip

Full Name

Relationship

Work Phone

Mobile Phone

Address

City, State, Zip

Parent/Guardian Signature

Parent/Guardian Signature

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