Free printable pickup authorization form for daycare.

The family lists every adult who may pick up their child. Staff check this list at every pickup.

It prints at the top of the form.

Authorized pickup form

Program
Child’s name
Date of birth
Room or group
Parent or guardian
Adults who may pick up
NameRelationship to the childPhonePhoto ID checked (staff initials)

Adults who may not pick up

Name
Relationship to the child
What staff should know

Court order or custody papers on file:YesNo

This list starts on
This list ends on (blank if it does not end)

Only the adults listed above may pick up my child. Staff may ask any of them for photo ID.

Parent or guardian signature
Date

Free printable form from bloomily.app/tools/forms

How to use this form

  1. Ask families to fill it in before the first day.
  2. Check the photo ID of anyone staff do not know against this list.
  3. Never release a child to an adult who is not on the list.
  4. Keep a copy at the door, with a copy of any court order.
  5. Ask the family for a new form whenever the list changes.

Check your state’s rules

Licensing rules decide how you release a child, and to whom. Check your state’s rules for written pickup permission.

Find your state’s licensing page

Do this in Bloomily

In Bloomily, each child has an approved pickup list. The record shows who dropped off, who picked up, and when.

See attendance and check-in

More free forms

Questions, answered

What if an adult who is not on the list comes for the child?

Do not release the child. Keep the child with staff, and call the parent.

Can a parent add someone for one day?

Ask for it in writing, signed by the parent, with the adult’s full name. Check their photo ID at pickup.

See it with your name on the door.

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