Non-Parent Pickup

Non-Parent Pickup Authorization

Child's Name

Non-Parent Name (Person Picking Up)

You can request one or more days on this form, as needed.

Date Picking Up

Time Picking Up

Authorizing Parent Email (Acting a signature)

Authorizing Parent Phone Number

Special Instructions ~ Information

By sending this request, the parent acknowledges their understanding that they are required to communicate to the non-parent that the non-parent that is picking up must ring the door bell, introduce themselves to the person in the office, indicate whom they are picking up, present their ID, and sign this authorization.

I agree to let the non-parent know of Courtyard's expectations.

Thanks for submitting. Remind your Non-Parent to ring the doorbell!