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Pick-up authorization form

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					                        Pick-Up Authorization Sheet

Child’s Name: ______________________________

Please list people who are authorized to pick-up your child from camp.

1. Name: _________________________             Phone Number: ______________________

Relationship to Child: _______________________________


2. Name: __________________________            Phone Number: ______________________

Relationship to Child: _______________________________


3. Name: __________________________            Phone Number: ______________________

Relationship to Child: _______________________________


4. Name: __________________________            Phone Number: ______________________

Relationship to Child: _______________________________

**If someone else other than those listed on this form is going to pick-up your child from
camp please send a note.

If there are access or custody restrictions, please inform staff.


I give permission for the people listed above to pick-up my child(ren) from camp.



_______________________________                        ______________________________
Name                                                   Date


________________________________
Signature

				
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