School Book Pickup Confirmation Form
Please complete this form to confirm the pickup of school books. Ensure all information is accurate for school records.
Student Full Name
*
First Name
Last Name
Student Grade/Class
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Student ID (if applicable)
List of Books Being Picked Up
*
Mathematics
Science
English Language Arts
History/Social Studies
Foreign Language
Physical Education
Art/Music
Other
Pickup Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pickup Time
*
Hour Minutes
AM
PM
AM/PM Option
Name of Person Picking Up
*
First Name
Last Name
Relationship to Student
*
Parent/Guardian
Sibling
Relative
Family Friend
Other
Contact Phone Number of Pickup Person
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email of Pickup Person
example@example.com
Special Instructions or Notes
Signature of Pickup Person
*
Confirm Pickup
Confirm Pickup
Should be Empty: