Child's Information
Parent/Guardian Information
Emergency Information
Individuals Other than Parent/Guardian Authorization
Only these individuals have my authorization to care for my child in the event of an emergency and/or for drop-off and pick-up. Please advise these individuals they are authorized and will need to present identification to staff.
Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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