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ALTERNATE PICK UP NOTIFICATION

Today’s Date:_________________________________________________________________ Name of Child:________________________________________________________________ Date of the alternate pick-up:_____________________________________________________ Name of person picking up child:__________________________________________________ Address of person picking up child: Telephone number of person picking up child: Driver’s License number of person picking up child:___________________________________ Parent’s Signature:_____________________________________________________________

ALTERNATE PICK UP NOTIFICATION Today’s Date:_________________________________________________________________ Name of Child:________________________________________________________________ Date of the alternate pick-up:_____________________________________________________ Name of person picking up child:__________________________________________________ Address of person picking up child: Telephone number of person picking up child: Driver’s License number of person picking up child:___________________________________ Parent’s Signature:_____________________________________________________________