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2026-27 Authorization to Pick Up Form

Student Information

Parent/Guardian Information

To allow adults other than the parents/guardians to pick up children, we must have their names on record in the office. If we are unfamiliar with a person picking up your child, we may ask for identification. All authorized persons must be 18+ in the state of Indiana.

Additional authorized persons to pick up student listed above:

Relationship to student
Answer required for "Relationship to student"
Relationship to student
Answer required for "Relationship to student"

Additional Contact Information

Relationship to student
Answer required for "Relationship to student"

As legal guardian of the student listed above, I authorize the additional person(s) to pick up my child from the Premier Arts Academy.

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