After-School Pick-Up Authorization Form

A form schools use to confirm who is authorized to pick up each student at dismissal and how to reach the family if something urgent comes up.

Use this template

Child's Name

First Name

Last Name

Grade

Parent/Guardian's Name

First Name

Last Name

Contact Number

Email Address

Pick-Up Person

First Name

Last Name

Relationship to Child

Transportation Method

Emergency Contact Name

First Name

Last Name

Emergency Contact Number

Additional Comments

Parent/Guardian Signature

Sign here

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