Just For Kids Authorized Pick Up Change Form - Summer 2020
NOTE: This form must be completed by the same parent(s) or legal guardian(s) who signed the original Enrollment Contract. If both parents signed the Enrollment Contract they must each complete a copy of this form using their own PIN. This change will remain in effect until the end of the current Enrollment Contract unless the parent completes a new Authorized Pick Up Change Form.
Email address *
Date of Change *
Just For Kids site child attends: *
Required
Child's First Name: *
Child's Last Name: *
Parent's First Name: *
Parent's Last Name: *
ADD the following person to the list of persons authorized to pick up the above named child:
First and Last Name
Please add only one person at a time. Both first and last names are required
Relationship to Child:
Primary phone number of authorized pick up person
Second phone number of authorized pick up person
Third phone number of authorized pick up person
Is this person currently registered as an authorized pick up person on another account at any Just For Kids location? *
DELETE the following person from the list of persons authorized to pick up the above named child:
Name of authorized pick up person to delete:
Parent PIN *
A copy of your responses will be emailed to the address you provided.
Submit
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