Pick Up Authorization I

    Pick  Up  Authorization     I  _______________________  give  permission  for  my  son/daughter,   _______________________________  to  be  picked  up  from  Sandpipers  Beach  Camp  by  the  following   people  if  I  am  unable  to  do  so.     NAME    

 

 

PHONE  #  

 

 

RELATIONSHIP  

1.___________________________________________________________________________   2.___________________________________________________________________________   3.___________________________________________________________________________   4.___________________________________________________________________________   5.___________________________________________________________________________     Parent/Guardian  Signature  _______________________________________   Date___________________