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Authorized Pick-Up Form
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Authorized Pick-Up Form
Authorized Pick-Up Form
If you are human, leave this field blank.
The individuals listed below are authorized to pick-up my child. I acknowledge and understand that the individuals I, the parent/guardian, list below are required to show valid, current, state approved identification prior to Somerset Academy, Inc. releasing my child. I understand that there are no exceptions to this policy.
Child ‘s First Name
Child’s Last Name
Section
Authorized Person #1
Phone Number
Relationship
End Section
Parent/Guardian Signature
Date Signed:
Date Received in Somerset Academy, Inc. Office
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