MSAS Student Sign-Out Form
This form must be completed for each student being picked up daily. If you have multiple people authorized for pickup for your student(s), please share this form with them. Do not submit the form until you are at the designated pick up location.
Student Last Name
Student First Name
Name of Authorized Person Picking Up Student
Authorized Person Phone Number
By checking the box below I acknowledge that this form serves as my electronic signature for daily sign-out. If it is determined that the authorized person picking up is not on premises when this form is submitted, the time may be altered by the afterschool site director to match time of pickup and the parent/guardian will be notified. Late charge may be applied.
Check here to authorize sign-out
Send me a copy of my responses.
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This form was created inside of School District of Palm Beach County.