Authorized Pickups Header Image

Authorized Pickup Information

Please provide the information for your authorized pickup below. 

Your Name*

Child Information

Child Name (If child has a sibling, please be sure to mark "Yes" after initial child information):*
Child Campus*
Will this authorized pickup apply to any siblings?*

Authorized Pickup/ Emergency Contact 1

Name:*
Address*

Authorized Pickup/ Emergency Contact 2

Name:*
Address*

Authorized Pickup/ Emergency Contact 3

Name:*
Address*

Electronic Signature

Enter Your Name*
Use your mouse or finger to draw your signature above
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