Centerville Elementary - Parent Pick Up Line Authorization Form

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Please fill out this form for each child you plan on picking up. Two signs will be made and delivered to your oldest child. The sign must be visible when picking up your child as it is confirmation that you are the parent, guardian or another person that has permission. Please note that if the sign is not visible, an ID will be needed to verify identity and permission. If you are in need of additional signs, please contact our main office at 763-792-5800.

How many children will you be filling this form out for? *

Child's Last Name *

Child's First Name *

Teacher's Name *

Brown (K)

Dorn (K)

Reistad (K)

Sigrist (K)

Hess (1)

Miller (1)

Sangren (1)

Sinna (1)

Read (1)

Allison (2)

Ford (2)

Manning (2)

Rands (2)

Davis (3)

Letko (3)

Weir (3)

Hamblin (4)

Mishler (4)

Shaw (4)

Mathison (5)

Pearson (5)

Valentini (5)

Grade *

Do you have another child you will be picking up? *

Yes

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