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Child
Name:___________________________________________________________
The
following people are NOW authorized to pick up child from Skribbles Learning
Center.
Mother:
YES
NO
Father:
YES NO
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Name:
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Relationship:
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Phone:
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Name:
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Relationship:
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Phone:
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Name:
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Relationship:
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Phone:
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The
following people are NOT authorized to pick up child from Skribbles Learning
Center.
Mother:
YES
NO
Father: YES
NO
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Name:
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Relationship:
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Phone:
|
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Name:
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Relationship:
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Phone:
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Name:
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Relationship:
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Phone:
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Is
there anyone specifically denied permission to pick up your child?
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Parent
signature:________________________________ Date:____________
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