SADI 2024 Student Authorized Parent/Guardian Pick-Up Form

Parents & Guardians: complete this form 3-5 days in advance of your student pick-up. Please submit a form for every instance of a student pick-up.

Please make sure the student is back on campus by 9:00pm at the latest so they are on time for the 9:30pm curfew!

Why do we require this form? Your submission is sent to Moore's Security and Residence Life teams to permit your student to leave campus with an authorized adult(s).

Student Info

Student: Full Name

Student Email

Pick-Up Info

Date of Pick-Up

Time of Pick-Up

Date of Return

Time of Return

Explanation of absence from the program

Authorized Adult Info

Authorized Adult(s): Full Name(s)

Authorized Adult(s): Phone Number(s)

I authorize for my child to be taken out of the program with this approved guardian at the date and time stated above.

Parent/Guardian Digital Signature

Parent/Guardian Email