Fundamentals Child Development Center, LLC

505-327-9073

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Authorized Pickup Form

Email*

First Name*

Last Name*

Child #1 Name*

Child #2 Name

Child #3 Name

I authorize the following people to pick up my child:

Name*

Relationship*

Phone #*

Name*

Relationship*

Phone #*

By checking this box I certify that I am in consent with all information submitted on this form*
Yes
Door Code*

Fundamentals Child Development Center
209 N Auburn
Farmington, NM
505-327-9073 / info[at]fundamentalscdc.com

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