Pickup Authorization Form

This is a temporary one-time authorization. If you want to add this

person permanently, please update your admission forms with the director.

I, ________________________________________________authorize the following

named person to pick up my child on the specified day and time.

I understand that it is a standard procedure to ask for a photo identification

upon this pickup. Without an I.D. Skribbles staff may NOT release your child.

Name of Child

Classroom/Teacher

Day of Pickup

Approx Time of pickup:

Name of person picking up:

Relationship to child:

Phone number of person picking up:

Parent Signature:_____________________________________________

Date:_________________________________________________________