Student Pickup
Please fill out this form in order for us to know who will be authorized to pick up your child from dismissal from school.
Email address *
Parent First Name and Last Name *
Student First Name and Last Name
Best Contact Number *
Grade *
Please provide the names of ALL adults that have permission to pick up your child from school.
Name #1 *
Name #2 *
Name #3
Name #4
Name #5
Name #6
A copy of your responses will be emailed to the address you provided.
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This form was created inside of NYC Department of Education. Report Abuse