Child Pickup Authorization Template

School / daycare release form — the parent or guardian signs on the spot to confirm collection of a child. One device, no printing.

Use this free child pickup authorization template to create, fill in and sign a child pickup authorization online. Self-sign in your browser — tamper-evident audit trail included.

Template preview

CHILD PICKUP AUTHORIZATION

[school]

Date: [date] Time: [time]

Child

Child name: [child name] Class / Grade: [class]

Collected by

Name: [guardian name]

Relationship to child: [relationship]

ID verified (type / number): [id ref]

I confirm that I am authorized to collect the above-named child and that the child was released to me at the time stated. Released by staff: [staff name].

Use this Child Pickup Authorization template →