Authorized Pick Up form — The Sunshine Club

AUTHORIZED PICK-UP FORM

This form is required Please let us know who, other than the child’s parent(s), is authorized to pick up the child from school. If someone is not listed on this form and attempts to pick-up your child, HMLC will not allow the child to leave and will contact parents immediately.

Name of person authorized to pick up

First Name

Last Name

Relationship to child

Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of person authorized to pick up