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PICK-UP AUTHORIZATION (ITP)

Please complete the form below. Required fields marked with an asterisk *

Child's Name*

Answer Required

Class*

Answer Required

Please list the names and cell phone #s of parents permitted to pick up you child(ren).*

Answer Required

If there are additional adults you would like to authorize to transport your child(ren) if necessary, please list his/her name, relationship and cell phone number.*

Answer Required

I understand I must inform the school in writing of any changes to my child's (children's) carpool information regarding who is permittted to transport to and from school.

Electronic Signature of Parent*

Answer Required