Authorized Pickup & Release of Student

Official school form

Lists exactly who may pick your child up, and who may not.

Release policy

Students are released only to a parent, guardian, or an adult named on this form. Photo identification is required for anyone the office does not recognize.

Changes to the pickup list must be made in writing by the enrolling parent — phone requests are confirmed by callback before a release is approved.

If a court order restricts contact with a parent or relative, a copy must be on file with the office for the school to enforce it.

Timing

Earliest drop-off is 7:30 AM. Students must be picked up within 15 minutes of dismissal unless prior arrangements are made.

Information to complete

Student full name *

Student date of birth *

Adults authorized for pickup — name, relationship, phone (one per line) *

Anyone NOT permitted to pick up this student

There is a court order on file affecting custody or contact.

Yes

Release plan

Parent pickup only
May be released to sibling age 18+
May walk or bike home with written notice

I confirm this list is current and I will notify the office in writing of any change.

Parent / guardian signature

Date

Solomon Heights Academy3200 NW 48th Street, Oklahoma City, Oklahoma 73112Authorized Pickup & Release of Student

Return completed forms to the school office at 3200 NW 48th Street, Oklahoma City, Oklahoma 73112.