Alternative Pick Up Form

Boulder Knoll Alternate Pick Up Permissions

The following people have permission to transport my child to or from school. They may be asked to provide identification prior to the school’s releasing my child to their care.

 

Name: ___________________________________________________________

Relation to Child: ________________________________________________

Phone: ___________________________________________________________

Address: __________________________________________________________

Alternate Phone: _________________________________________________

 

Name: _________________________________________________________

Relation to Child: ________________________________________________

Phone: ___________________________________________________________

Address: __________________________________________________________

Alternate Phone: _________________________________________________

 

Name: ____________________________________________________________

Relation to Child: ________________________________________________

Phone: ___________________________________________________________

Address: __________________________________________________________

Alternate Phone: _________________________________________________

 

Name: ____________________________________________________________

Relation to Child: ________________________________________________

Phone: ___________________________________________________________

Address: __________________________________________________________

Alternate Phone: _________________________________________________

 

______________________________                   

Parent Signature Required                                                        

Please be certain that all drivers be aware of our driveway procedures.

We appreciate prior notice if a new driver is picking up your child.