CHILD PICK UP RELEASE

The following individuals have permission to pick up my child (not including legal parent or guardian):

Child's Name *
Child's Name
Pick Up Name 1 *
Pick Up Name 1
Phone *
Phone
Pick Up Name 2
Pick Up Name 2
Phone
Phone
Pick Up Name 3
Pick Up Name 3
Phone
Phone
Pick Up Name 4
Pick Up Name 4
Phone
Phone
Parent or Guardian Name *
Parent or Guardian Name
Today's Date *
Today's Date