Just For Kids Authorized Pick Up Change Form

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Just For Kids Authorized Pick Up Change Form - Summer 2025

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.

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.

This form will allow you to add and/or delete up to 3 people. If you need to add or delete additional people, please fill out a 2nd form.

Email *

Date of Change *

YYYY

Just For Kids site child attends: *

Amity

Cynthia Mann

Grace Jordan

Lowell

Riverside

Valley View

White Pine

Whitney

Trail Wind

Other:

Child's First Name: *

Child's Last Name: *

Parent's First Name: *

Parent's Last Name: *

Do you need to add and Authorized Pick Up? *

Yes

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