Student Name: _______________________________________________ Grade: ___________ Homeroom Teacher: __________________________________________ 7th Period Teacher (6th -8th Grade Only): _________________________________ I, ________________________________, authorize my child _________________________ to walk/bike to Parent/Guardian Name (Print) and/or from school. Check One: My Child will be walking/biking home alone A walking adult will pick up my child from school at the designated pick-up location Parent Name: ___________________________________________________ Student Address: ___________________________________________________ Phone #: ___________________________________________________ **I understand that per campus policy, my student must be a registered walker/biker and must walk/bike directly to and from school. Parent Name: Parent Signature:
Student Name: _______________________________________________ Grade: ___________ Homeroom Teacher: __________________________________________ 7th Period Teacher (6th -8th Grade Only): _________________________________ I, ________________________________, authorize my child _________________________ to walk/bike to Parent/Guardian Name (Print) and/or from school. Check One: My Child will be walking/biking home alone A walking adult will pick up my child from school at the designated pick-up location Parent Name: ___________________________________________________ Student Address: ___________________________________________________ Phone #: ___________________________________________________ **I understand that per campus policy, my student must be a registered walker/biker and must walk/bike directly to and from school. Parent Name: Parent Signature: