CHANGE IN STUDENT PICK-UP FORM

This page is ONLY for current students/parents of Nrityaniketan

***Only applicable for student below 18 years of age

FIRST NAME OF THE STUDENT

LAST NAME OF THE STUDENT

GROUP (Day and Time of their class/batch)

CLASS DATE FOR CHANGE IN PICK-UP (Month, date and Year) (For multiple dates, please specify all the dates/time-period clearly; If it is permanent authorization, mention “Permanent”)

FULL NAME OF PERSON AUTHORIZING THE CHANGE

RELATIONSHIP TO THE STUDENT MENTIONED ABOVE

EMAIL OF PERSON AUTHORIZING THE CHANGE

Is the person picking up, a parent of another current Nrityaniketan student- If YES, please fill the next section; If NO, please say N/A in the next section and fill necessary details in the last section

If the person picking up is a parent of another current Nrityaniketan student, please give these details: 1. Full Name of that Student, 2. Full Name of that Parent, AND 3. Day and Time of the group/batch they belong to

FULL NAME OF THE PERSON AUTHORIZED TO PICK UP That person (family member/friend/anyone else etc.) should bring a proper ID (driver’s license or passport)

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