Parents place
photo here of the
older child who is
picking up your
PASAR student
2015-2016
My PASAR campus is: _______________________
A new release form must be completed every year.
One form per PASAR student.
One form per Under 18 pick-up student.
Check here if
you have an
additional
student
and form.
Under 18 Release Form
OLDER CHILD MUST BE 13 YEARS OF AGE OR OLDER, MUST BE ON THE
AUTHORIZED PICK UP LIST VIA THE PARENT PORTAL AND SHOW A PICTURE
ID EACH TIME
My son/daughter, ___________________________________may be released
Circle one
PASAR Student’s First and Last Name
to _____________________________________ from PASAR.
Person Under 18 First and Last Name
I, ______________________________________________, give my permission
Parent/Guardian
(please print)
for the above under 18 person to pick up my PASAR student.
Sign______________________________________ Date___________________
Parent/Guardian Signature
Notary____________________________
name
Date___________________
Notary Stamp