Pickup Authorisation Form
Who may collect the child: authorised adults, restrictions, and a signed record.
9 questions · 1 page · about 6 minutes to answer · fully editable after you start
Pickup authorisation is childcare's most safety-critical paperwork, and it changes – new partners, custody arrangements, visiting grandparents. This form maintains the record properly: authorised adults with identifying details, any explicit restrictions stated plainly, the password option for extra verification, and the signed, dated authority.
Re-issue it at every enrolment anniversary and whenever a family mentions changed circumstances; the current record is the one that protects everyone at the door.
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Pickup authorisation
Use this form to tell us who may collect your child. Only the adults named here will be allowed to collect them, so please check the details carefully. It takes about 6 minutes. Please do not include other children's names or details in your written answers.
Q1.Child's name and room/class*
Q2.First authorised adult*
Q3.Their relationship to the child*
Q4.Second authorised adult (optional)
Q5.Their relationship to the child, if you added a second adult
Q6.Is anyone explicitly NOT authorised? State plainly, or write None.*
Q7.Add a family pickup password for extra verification?
- Yes - staff will record it with you privately
- Not needed
Q8.Date of this authorisation*
Q9.Parent/guardian signature*
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