Springs Adventist Academy Authorized Pick-Up Form
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Email *
Today's Date *
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Student Name(s) *
My student(s) is/are authorized to be picked up by the list of drivers provided below. I understand that under no circumstances will the Springs Adventist Academy staff be allowed to release the above student to anyone unless listed below. I understand that all unrecognized drivers will be asked to show identification and their ID will be checked against the list below. I understand that students will not be released on foot/bicycle unless written consent is attached to this form, including written permission to walk to the bus stop.  PLEASE INCLUDE PARENTS/GUARDIANS ON LIST. *
Required
Approved Driver #1 - Full name, relationship to student, phone number *
Approved Driver #2 - Full name, relationship to student, phone number
Approved Driver #3 - Full name, relationship to student, phone number
Approved Driver #4 - Full name, relationship to student, phone number
Approved Driver #5 - Full name, relationship to student, phone number
Approved Driver #6 - Full name, relationship to student, phone number
Approved Driver #7 - Full name, relationship to student, phone number
Approved Driver #8 - Full name, relationship to student, phone number
Approved Driver #9 - Full name, relationship to student, phone number
Approved Driver #10 - Full name, relationship to student, phone number
Your typed signature indicates your understanding and acceptance of this document. *
A copy of your responses will be emailed to the address you provided.
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