# Authorized Pickup Person Form

**School name:** ________________________________

**Student name:** _______________________________

**Class / grade:** ______________________________

**Parent / guardian name:** ______________________

**Parent / guardian phone:** _____________________

## Person being authorized

**Full name:** __________________________________

**Relationship to student:** _____________________

**Phone:** ______________________________________

**Email:** ______________________________________

**Government ID type / number, if required by School policy:** ______________________________

## Permission granted

I authorize the person named above to pick up the student from the School according to School policy. I understand that the School may record this authorization in its digital school operations system and may use it to help staff identify and verify approved pickup persons.

## School-side notes

Use this area for any internal instructions that staff must verify manually. These notes are not automatically enforced by the digital system.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

## Parent / guardian acknowledgement

I understand that:

- The School may require identification before releasing the student
- The School may require digital confirmation before pickup is completed
- The authorized person must follow School arrival and dismissal procedures
- I must notify the School if this authorization changes or should be removed
- The School may deny release if authorization cannot be verified by staff

**Parent / guardian signature:** ______________________________

**Printed name:** ____________________________________________

**Date:** ____________________________________________________

## Authorized person acknowledgement

I agree to follow the School's pickup and drop-off procedures. I will not share my account, QR code, password, or pickup authorization with another person.

**Authorized person signature:** ______________________________

**Printed name:** ____________________________________________

**Date:** ____________________________________________________

## School use only

Approved by: ______________________________

Date approved: ____________________________

Entered in digital system by: ______________________________

Notes: _______________________________________________________

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**Template note:** This sample is provided for general onboarding and operational support. Schools should review and adapt it to their own policies, legal requirements, and local regulations before use.