Student Pickup Authorization
Lists the adults authorized to pick a student up from school, with relationship and contact info.
Student Pickup Authorization
JaxForm
Student Pickup Authorization
Please list the adults, other than yourself, who are authorized to pick up your child from school. This ensures your child’s safety and helps us keep accurate records.
Student’s Full Name*
Authorized Adults
Please provide details for adults authorized to pick up your child. They may be asked for photo ID.
Adult 1 Full Name*
Adult 1 Relationship to Student*
Adult 1 Phone Number*
Adult 2 Full Name
Adult 2 Relationship to Student
Adult 2 Phone Number
Adult 3 Full Name
Adult 3 Relationship to Student
Adult 3 Phone Number
Parent/Guardian Confirmation
Parent/Guardian Full Name*
First
Last
Date*
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