Pick-Up Authorization

HSLP automatically authorizes the adults on the school registration form to pick up their child. To ensure the safety of the students, all adults picking up a child must have prior approval from the parent/guardian. If a person is not included on this list, we will not let your child go home with them without your permission. Please list adults on the form who may pick up your child in your absence.

Child's Name

First Name

Last Name

The following adults may pick up my child

Name--Relationship--Contact Number

Additional Pick-Up Notes

including any family members who may pick up on a regular schedule or specific individuals who are not allowed to pick-up your child

If your authorized pick-up list changes, please notify the teachers as soon as possible. If a person is not included on this list, we will not let your child go home with them without your permission.

Form Completed by

First Name

Last Name

Pick-Up Authorization

Holy Spirit Lutheran Preschool