Authorization Form For Alternate Pick Up

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Authorization Form For Alternate Pick Up
Child’s Name_________________________________________________
Parent’s Name________________________________________________
I give permission to __________________________ (relationship____________________)
__________________________ (relationship____________________)
__________________________ (relationship____________________)
__________________________ (relationship____________________)
__________________________ (relationship____________________)
to pick-up my child from Ms .Jean’s Child Care center.
Parent’s Signature________________________________ Date_____/_____/_____
Provider’s Signature________________________________ Date_____/_____/_____

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