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Dismissal Authorization

Please complete the form below. Required fields marked with an asterisk *

Student(s) Name (Please list all of your children who are attending St. Egbert this year.)*

Answer Required

Last Name*

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Primary Phone*

Number Required

Please list other adults who have permission to pick up your child(ren). Be sure to include all information.

When someone other than the parents pick up a student, they will need to show a picture ID, such as a driver's license, so that we can be sure the person you listed is the person who is picking up your child.

1. Please give the Name, Phone number, and Relationship to your child:

Answer Required

2. Please give the Name, Phone number, and Relationship to your child:

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3. Please give the Name, Phone number and Relationship to your child:

Answer Required

4. Please give the Name, Phone number and Relationship to your child:

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Confirmation Email

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