other authorized guardian

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OTHER AUTHORIZED GUARDIAN Date: ___________________ LEGAL GUARDIAN Information Name: __________________________________________ Cell Phone: (_____) _____- ________

Names of Children in your Household who this Other Authorized Guardian has your permission to pick up: 1: __________________________ 2: __________________________ 3: __________________________ 4: __________________________

OTHER AUTHORIZED GUARDIAN Information Name: __________________________________________ Relationship to Children: ______________________________________ Cell Phone: (_____) _____- ________ Verizon Texting? □ Yes □ No Skip the rest only if you are sure their Household is already registered in our system: Email: ______________________________________________ Street: ____________________________________________________ City/State/Zip: ______________________________________________

Friends Church Office Use: □ PP □ F1