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Alternate Pickup Authorization Form
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Child's last name
Your answer
Child's first name
Your answer
The following people have permission to pick my child up from school:
1. Name
Your answer
Relationship to Child
Your answer
Phone Number
Your answer
2. Name
Your answer
Relationship to Child
Your answer
Phone Number
Your answer
3. Name
Your answer
Relationship to Child
Your answer
Phone Number
Your answer
4. Name
Your answer
Relationship to Child
Your answer
Phone Number
Your answer
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