| Name: | Name: |
| Address: | Address: |
| Home #: | Home #: |
| Work #: | Work #: |
| Pager/Cell #: | Pager/Cell #: |
| Relationship to child: | Relationship to child: |
(if different from above)
| Full Name: | Relation: |
| Full Name: | Relation: |
| Full Name: | Relation: |
| Password: |
Person's allowed to remove a child from my childcare will be required to provide a password known by all three parties, along with valid photo ID, before they will be able to remove the child from my childcare. Please understand that this precaution is for the child(ren)'s safety and protection.
Kelly's Home Childcare
www.geocities.com/kellyshomecc
