St. Luke's Academy

The International School
Inspiring Excellence

St. Luke's Academy

Temporary Collection Authorisation Form

Important Notice

This form is to be completed when a student is being collected by a person who is not already listed on the shcool's authorised collection list.

Student Information

Class

Collection Details

Alternative Collector Details

Parent/Guardian Authorisation

I confirm that the above-named person is temporarily authorised to collect my child on the stated date and time. I understand that this person is not on the standard authorised pick-up list and that identification and password verification may be required by the school.

Clear Signature

For School Use Only

ID Verified
Password Confirmed
Clear Signature