Dear Parent/Guardians/Caretakers:

Please make sure we have your most current contact information on file by completing this form.
Additionally, we want to make sure your child is safe at all times, so please complete section two of this form.
Should it be necessary for someone not on the list to pick up your child, please call the school ahead of time to notify the staff and please notify the person picking up your child that we will require standard identification.

It is possible that, we may call you or require that the individual call you in our presence to verify that he or she has been authorized by you to pick up your child, and is in the process of picking up your child.

We acknowledge this may be burdensome, but we are sure that you will agree with us that your child's safety is most important.  


Please read and sign this letter.

Thank you for your cooperation.

 
This will grant my (our) permission for my (our) son or daughter, (ENTER CHILD FULL NAME BELOW)
 
in the (ENTER GRADE BELOW) grade at Hazelwood  Elementary Middle School during this (SY 2020-2021) school term, to be picked up by the individuals listed below, in the order of their listing. I do understand that my child/children will not be dismissed into the care of anyone not indicated on this list. Please list self or other parent or guardian as primary and all others afterwards. Feel free to list relationship to child for each designee given.