1307 S. Park Drive | Reidsville, NC | 336.349.6085

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South End Elementary

Student Emergency/Sign-Out/Pickup Information

 

Please complete this form and return to your child’s teacher.   We will keep this information on record for the school year.  If any of this information changes, please contact Kim Williams,Data Manager @ 349-6085.  Please notify the necessary individuals you note below and ask them to always have a picture ID when signing out/picking up your child as we will ask to see it to ensure your child’s safety.

 

** Please remember that for custodial issues, a court document must be present in the child’s file in order for either parent to be denied the ability to sign out their child.

 

Thank you for your help in keeping all of our children safe! Angela Martin, Principal

 

Student’s Name ___________________________________________

Teacher _________________________

Grade Level  _____________

 

Indicate the name, relationship, and phone numbers of anyone for whom you allow your child to be signed out/picked up from school.  Include any daycare services that may pick up your child.  We will only allow those noted below to sign out/pick up your child from school upon receiving this form in our office.  If you wish to add/delete someone to the list, you must visit our Data manager's office and amend the form in person.  The first set of lines are for primary parent/guardian information.  Thank you again for your commitment to our students’ safety.

 

Name ___________________________________ Relationship to student PARENT/GUARDIAN

Home Phone _________________________ Cell Phone ___________________

Work Phone ________________________

 

Name ___________________________________ Relationship to student _________________

Home Phone ________________________ Cell Phone ___________________

Work Phone ________________________

 

Name ___________________________________ Relationship to student _________________

Home Phone ________________________ Cell Phone ___________________

Work Phone ________________________

 

Name ___________________________________ Relationship to student _________________

Home Phone ________________________ Cell Phone ___________________

Work Phone ________________________

Last Modified on January 24, 2014