PICK UP/ ACCESS INFORMATION
PLEASE TURN OVER
AUTHORIZED PERSONS FOR EARLY DISMISSAL
In the event of an early dismissal, parents/guardians
or
the following individuals are authorized to sign them out:
Name Relationship PhoneName Relationship PhoneName Relationship Phone
PERSONS WITH RESTRICTED ACCESS TO STUDENTS
Name Relationship NotesName Relationship Notes
SUMMER SCHOOL PICK UP
Who will be picking up your child from Summer School?
Name Relationship PhoneName Relationship PhoneName Relationship Phone
SCHOOL YEAR PICK UP
Who will be picking up your child from school during the year?
Name Relationship PhoneName Relationship Phone
[PLEASE INFORM KIPP ACADEMY ELEMENTARY OF ANY CHANGES TO THE ABOVE LISTS]
STUDENT INFO
Name
(Last) (First) (Middle)
Email Address where we can reach you: __________________________________________________________
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KIPP Academy Elementary Family Pick-Up Contact Form
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| Category: | Uncategorized. |
| Rating: | |
| Upload Date: | 11/24/2009 |
| Copyright: | Attribution Non-commercial |
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