Add/Changed Authorized Pickup

Please complete this form for additions or removals to any record of your child's pickup authorizations,

*This form is accessible via mobile devices. However, desktop devices are best for optimal functionality. An inoperative “submit” button indicates that some form fields are missing or typed incorrectly. Desktop devices will describe any necessary corrections that hinder submissions, but mobile forms do not have this function.

Please note: This form is for school records and separate from DashPass. You must additionally add or change authorized pickup individuals in the Dashpass app.

Student Name (First and Last)

Parent Name (First and Last)

Parent Phone Number

Parent Email Address

I authorize the following individual to pick up my child in my absence:

Authorized Pickup Name

Authorized Pickup Relationship

Authorized Pickup Phone

I would like to remove pickup authorization from the following individual currently on file:

Name (First and Last)

Agreement
(Check) I understand the following: Mainspring Academy staff will contact me to verify the above changes. Mainspring Academy requires written parent authorization through an Add/Change Request Form in order to make changes to the student’s pick up/drop off list. The school will not accept verbal or text message authorizations. Mainspring Academy requires photo identification for any individuals I authorize to pick up/ drop off my child in my absence. School drop-off begins at 8:25am unless students are enrolled in the Extended School Day Program. I will be responsible for Extended School Day Program fees if my child is dropped off by any authorized individuals during morning Extended Care hours. I will be responsible for late pickup penalties of any individuals I authorize to pick up/ drop off my child in my absence.

Add/Changed Authorized Pickup

Please complete this form for additions or removals to any record of your child's pickup authorizations,

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