The New Village - AUTHORIZATION TO RELEASE/PICK-UP STUDENT 2023-2024

AUTHORIZATION TO RELEASE/PICK-UP STUDENT

One form for each student please
All students should have at least two people authorized to pick them up from school in case the parents are unable to, or in the case of an emergency
Student Name*

Last NameFirst Name
Date of Birth*

MonthDayYear
Date
Grade Level*
Adult 1 Emergency Contact*

Last NameFirst Name
Adult 1 Phone*
Please enter a valid phone number.
Relationship*
Adult 2 Emergency Contact

Last NameFirst Name
Adult 2 Phone
Please enter a valid phone number.
Relationship
I understand that school faculty or staff may take my child home if I am unable to, or in the case of an emergency.
Please check the following box if you would like parents of the New Village School to pick up your child

Yes, I give your permission for my child(ren) to be released to any parent or guardian of any child-enrolled in the New Village School. The parent picking up my child will coordinate directly with me.
Should be Empty: