Consent for Pick Up

Consent for Pickup Form

Check one please*

Pickup for virtual packagesStudent on campus pickup

As the undersigned parent or guardian of the following student(s) at NHVA,

Student Name*

I give permission for my student(s) or virtual package to be picked up from school by the following people: (please include yourself)

Name (Person 1)*

Phone*

Name (Person 2)*

Phone*

Name (Person 3)*

Phone

Name (Person 4)*

Phone*

My child(ren) is NOT allowed to ride with or virtual packages are not allowed to be picked up by:

Name*

This consent shall remain in continuous effect until revoked in writing and delivered to the above named school or until the student is no longer enrolled in the above named school.

Signature of Parents or Legal Guardian*