Student Self-Walker Authorization Form
Authorize your student to travel home or between locations unaccompanied. Please complete all required information below.
Student's Full Name
*
First Name
Last Name
Student's Grade
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Approved Self-Walk Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Approved Self-Walk Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Authorized Destinations or Routes
*
Parent/Guardian Signature
*
Submit Authorization
Submit Authorization
Should be Empty: