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🚙Student Pickup Authorization Form Template

School Year ______

Safety is our number one priority at Seascape Academies. Seascape Academies is a safe place for children to learn, play and grow.

If you want any other adult to pick up your child, you must complete this form first. Please make sure it is signed by both parents/guardians so that we know they agree with this policy.

If anything happens while your child is at Seascape Academies that makes you uncomfortable or unsafe, please let us know immediately so we can take action immediately.

Student Name

Today's Date

Parent/Guardian 1 Name

Parent/Guardian 1 Signature

Parent/Guardian 1 Signature

Parent/Guardian 2 Name

Parent/Guardian 2 Signature

Parent/Guardian 2 Signature