Authorization for Pick Up Form

Date
MM slash DD slash YYYY
Student's Name*
First Last
Parent's Name*
First Last
Email*
Persons authorized to pick up my child/ren must be listed below. Included are parents, relatives, carpool drivers, friends, babysitters/nannies, etc. I understand that any of these people may be asked to provide identification to the staff at HSPK.
Name*
First Last
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Name
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
Name
First Last
Phone
Address
Street Address Address Line 2 City State ZIP Code
E-signature Acknowldgment*
By checking this box, I acknowledge that I am electronically signing this document.
Typed Signature*