E3 PickUp Form – E3 Christian Academy

E3 Academy

E3 Academy PickUp Form

Please fill out the E3 Academy Pickup Form below. Ensure all student information and institutional policies are fully reviewed before submitting

Pick-Up Authorization Form

Children Details

Please list all children enrolled at E3 Christian Academy covered under this authorization form:

Child's Full Name *

Grade *

Authorized Persons for Pick-Up

Only the following authorized persons may pick up my child/children from school:

Authorized Name *

Phone Number *

Alternate Phone

Relationship *

Custody & Special Notes

If you are divorced, we must know who has custody of your child. Please also indicate if any parent is NOT permitted to pick up your child. Provide any additional information that may be beneficial for your child's teacher to know regarding your family circumstance:

Verification & Execution

Printed Name of Parent or Legal Guardian *

Digital Signature *

Date *

E3 Academy

E3 Academy PickUp Form

Pick-Up Authorization Form

Real World Learning In A Christ Centered Environment

E3 Academy

Real World Learning In
A Christ Centered Environment