• Child's Info

  • Father's Info

  • Mother's Info

  • Legal Guardians

  • The child may be released to the person(s) signing this agreement or to the following:

  • (Streen-City-State-Zip)
  • HomeWorkCell 

  • (Street-City-State-Zip)
  • HomeWorkCell 

  • (Street-City-State-Zip)
  • HomeWorkCell 
  • Emergency Contact

  • NameNumber 
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