Pickup/Emergency Contact

Section 14: Pick up Policy and Authorization Form
Name of Parent/Gaurdian
First Last
Name of Student
First Last
grade
Name
First Last
Relation
Phone
Name
First Last
Relation
Phone
Name
First Last
Relation
Phone
Name
First Last
Relation
Phone
Agree*
- Yes
Date
MM slash DD slash YYYY
Section 15: Emergency Contact and Medical Authorization Form
Parent/Gaurdian
Full Name
Students Name
Full Name
*
- I authorize any employee staff of Manarah Islamic Academy to take my child to the nearest hospital for Student emergency-related medical treatment. I agree to hold Manarah Islamic Academy harmless for any unforeseen accident in the school or on the school grounds.
Name
full name
Relationship
Phone
Name
full name
Relationship
Phone
Name
full name
Relationship
Phone
Agree
- Yes
Date
MM slash DD slash YYYY
CAPTCHA