Pickup

Pick-Up Authorization Form (one per family)

* Indicates required field

Child 1 Name *

First

Last

Child 2 Name *

First

Last

Child 3 Name *

First

Last

Child 4 Name *

First

Last

The people listed below have my authorization to pick up my child(ren) from Fairlawn Lutheran School (in addition to parents) . I will inform the Fairlawn Lutheran School Director each time a special pick-up is necessary.

Pick-up Contact 1 Name *

First

Last

Pick-up Contact 1 Relation to Child *

Pick-up Contact 1 Phone *

Pick-up Contact 2 Name *

First

Last

Pick-up Contact 2 Relation to Child *

Pick-up Contact 2 Phone *

Pick-up Contact 3 Name *

First

Last

Pick-up Contact 3 Relation to Child *

Pick-up Contact 3 Phone *

I understand that my child will only be released to one of the above listed individuals after they have presented proper identification and signed the Child Release Form. I further understand that my child will not be released to anyone else unless written instructions have been given by me to the school director or teacher. By typing your FULL NAME as an electronic signature you are indicating your acceptance of the terms herein.

Parent Signature *

Date *

Submit