Pick Up Authorization

Name of Child*

First Last

Grade of Child*

Authorization

Please fill the information below if the child is not picked up by the parents.

Name of Person 1 Authorized to Pick up*

First Last Relation to the child

Phone Number of Person 1 Picking up*

Phone Number #2 of Person 1 Picking up

Name of Person 2 Authorized to Pick Up

First Last Relation to the child

Phone Number of Person 2 Picking up

Phone Number #2 of Person 2 Picking up

Parent Email*