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Authorized Pickup Form
First Name
*
Last Name
*
Email Address
*
Child #1 Name
*
Child #2 Name
Child #3 Name
I authorize the following people to pick up my child:
Name
*
Relationship
*
Phone #
*
Name
*
Relationship
*
Phone #
*
By checking this box I certify that I am in consent with all information submitted on this form
*
Door Code
*
Prove you're not a robot
*
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