South End Elementary
2009-2010 Student Emergency/Sign-Out/Pickup Information
Please complete this form and return to your child’s teacher by Friday, August 29, 2009. We will keep this information on record for the 2009-2010 school year. If any of this information changes, please contact Linda Thompson, NCWISE 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 may 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! Elizabeth Lynch, 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 NCWISE 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 ________________________
