Caregiver Authorization Form

Step 1 of 2

Child(ren) Name(s)(Required)

I give permission for my children to be transported in my child's caregiver vehicle for the following reasons: (Check all that Apply)(Required)

Before / After School Pick-Up or Drop-Off

Dr. Appointment

Sick Call Pick-Up

If my child is sick, first contact:(Required)

Mom

Dad

Caregiver

If that person cannot be reached, contact:(Required)

Mom

Dad

Caregiver

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Caregiver Name	Caregiver Phone Number	Caregiver Email	Caregiver Car Make and Color	Actions

There are no Caregivers.