Pick-Up Authorization Parent/Guardian Contact InformationName of Parent/Guardian Authorizing Pick-Up(Required) First Last Cell Phone(Required)Email(Required) Child & Classroom InformationChild(ren) Covered by this Authorization(Required)Use the “+” to add each child this person is authorized to pick up. Make sure to select the correct class for each child or authorization will not be granted.Child FirstChild LastChild Class Mon 2AMon 2BMon 3/4Mon 5Tue 2ATue 2BTue 3/4Tue 5Wed 2AWed 5 Add RemoveAuthorization InformationName of Authorized Individual(Required)Please provide this information as it appears on their driver’s license or ID First Last Cell Phone(Required)Please provide their cell phone number in the event that we need to contact them regarding pick-upDate of Pick-Up(Required)The date on which the pick-up authorization begins. MM slash DD slash YYYY Is this an ongoing authorization?(Required)Ongoing authorizations can be rescinded at any time by contacting Shari Mellinger via email. Yes, this person is authorized to pick up my child(ren) for the rest of the year. No, this authorization is for the above date only.
