St. Luke's Academy

Inspiring Excellence

St. Luke's Academy

Consent Form for Collection of students from St. Luke's Academy

TO BE COMPLETED BY PARENTS/GUARDIANS:

The named adults below have my authorisation to collect my child/ward from St. Luke’s Academy in my absence. I request (fill in below) security decals which I agree to return once my child/ward is no longer enrolled at St. Luke’s Academy. Two (2) stickers are complimentary; $5 for each additional decal sticker.

Student Collection Form

Fields marked with an * are required

Name of Student
My Chosen password for person not listed above to collect my child/ward is:

It is the parent's/guardian's responsibility to inform St. Luke's Academy of any change that may occur to the authorised person's collection and/or to any change required to the password. I agree to update St. Luke's Academy's administrators with any changes.

Mother's/Guardian's Name
Father's/Guardian's Name

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