2016-2017 LOWER SCHOOL STUDENT PICK-UP AUTHORIZATION
2016-2017 LOWER SCHOOL STUDENT PICK-UP AUTHORIZATION
Child’s Name ____________________________________________ Grade _____________ Child’s Name ____________________________________________ Grade _____________ Child’s Name ____________________________________________ Grade _____________ Child’s Name ____________________________________________ Grade _____________ will be picked up routinely by: Parent/Guardian Name ____________________________________ Phone ________________ Parent/Guardian Name ____________________________________ Phone ________________ Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
If someone other than those persons listed above will be picking up your child/ren, you must call the school office with the name of that person. That person must present a photo ID of him/herself before the student will be released. Students who are not picked up by 12:30 p.m. (early dismissal days) or by 3:30 p.m. will be charged late fees as stated in the parent handbook. If you plan to use BASC on a drop-in basis, you must call the school office to reserve a spot. If you fail to reserve a spot and leave your child in BASC, BASC fees will apply as outlined in the parent handbook.
_______________________________________________________ Parent/Guardian’s Signature
_________________ Date
Child’s Name ____________________________________________ Grade _____________ Child’s Name ____________________________________________ Grade _____________ Child’s Name ____________________________________________ Grade _____________ Child’s Name ____________________________________________ Grade _____________ will be picked up routinely by: Parent/Guardian Name ____________________________________ Phone ________________ Parent/Guardian Name ____________________________________ Phone ________________ Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
Other—Name
____________________________________ Phone ________________
If someone other than those persons listed above will be picking up your child/ren, you must call the school office with the name of that person. That person must present a photo ID of him/herself before the student will be released. Students who are not picked up by 12:30 p.m. (early dismissal days) or by 3:30 p.m. will be charged late fees as stated in the parent handbook. If you plan to use BASC on a drop-in basis, you must call the school office to reserve a spot. If you fail to reserve a spot and leave your child in BASC, BASC fees will apply as outlined in the parent handbook.
_______________________________________________________ Parent/Guardian’s Signature
_________________ Date
