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.
* Required
Email address
*
Your email
Date of Change
*
Your answer
Just For Kids site child attends:
*
Amity
Cynthia Mann
Garfield
Grace Jordan
Horizon
Liberty
Lowell
Riverside
Shadow Hills
Trail Wind
White Pine
Whitney
Required
Child's First Name:
*
Your answer
Child's Last Name:
*
Your answer
Parent's First Name:
*
Your answer
Parent's Last Name:
*
Your answer
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
Your answer
Relationship to Child:
Parent
Step Parent
Sibling
Grandparent
Aunt
Uncle
Other Relative
Family Friend
Neighbor
Other
Primary phone number of authorized pick up person
Your answer
Second phone number of authorized pick up person
Your answer
Third phone number of authorized pick up person
Your answer
Is this person currently registered as an authorized pick up person on another account at any Just For Kids location?
*
Yes
No
Unknown
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:
Your answer
Parent PIN
*
Your answer
A copy of your responses will be emailed to the address you provided.
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