| Little Steps Childcare Child Pickup Authorization Form Date______________ Child(ren) Name(s)_____________________________________ Below are the authorized person/people who may pick up my child(ren). Name______________________________________________________ Address____________________________________________________ Relationship_________________________________________________ Phone#______________________ Cell#_____________________ Name______________________________________________________ Address____________________________________________________ Relationship_________________________________________________ Phone#______________________ Cell#_____________________ Any person(s) NOT authorized to pick up your child. ___________________________________________________________ Note: Any person unfamiliar with me will be required to show proof of identification. Under NO circumstances will the child be released to anyone other than those listed above without WRITTEN permission from the parent/guardian. Parent/Guardian Signature_______________________________________ Parent/Guardian Signature_______________________________________ Date_________________ |
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