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2009 FCC Summer Theatre Program Pick Up Authorization
Name of Camper: _________________________________________________________
_________ YES, MY CHILD MAY GO HOME ALONE AFTER CAMP.
_________ NO, MY CHILD MAY NOT GO HOME ALONE AFTER CAMP.
I AUTHORIZE THE FOLLOWING PEOPLE TO PICK UP MY CHILD.
NAME: _______________________________________________________________
PHONE NUMBER: ______________________________________________________
ADDRESS: _____________________________________________________________
NAME: _______________________________________________________________
PHONE NUMBER: ______________________________________________________
ADDRESS: _____________________________________________________________
NAME: _______________________________________________________________
PHONE NUMBER: ______________________________________________________
ADDRESS: _____________________________________________________________
NAME: _______________________________________________________________
PHONE NUMBER: ______________________________________________________
ADDRESS: _____________________________________________________________
NAME: _______________________________________________________________
PHONE NUMBER: ______________________________________________________
ADDRESS: _____________________________________________________________
Parent's Signature: _____________________________________________________ |