Reunification Information (PLEASE PRINT CLEARLY)

Have photo identification out and ready to show school district personnel.

Student Name ..............................................................................................................................

Student Grade .................................... Student Cell Phone Number .........................................

Name of person picking up student ............................................................................................

Signature .....................................................................................................................................

Phone number of person picking up student ...............................................................................

Relationship to student being picked up ......................................................................................

Photo identification matches name of person picking up student? Y or N

Parent completes:
Print Student Name Again ............................................................................................................

Student Grade .........................................School personnel completes upon release of student .......................................................................................................................................................

Student Birthday ........................................................^T.^I.^M..^E ....................... ^I.^N..^I.^T.^I.^{ALS            OTHER}