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Authorization Form for Car Rider/Walkers for 2020-2021
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* Indicates required question
Student Full Name:
*
Your answer
Grade/Homeroom
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Your answer
Contact Person
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Your answer
Relationship to student
*
Your answer
Phone Number
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Your answer
Alternate Phone Number
*
Your answer
Emergency Contact
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Your answer
Relationship to Student
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Your answer
Phone Number
*
Your answer
Alternate Phone Number
*
Your answer
I give permission for the above-mentioned student to be a: (only check one)
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Car Rider PM
Walker PM
By typing my name below as Legal Guardian I give my permission for the student to be a walker/car rider as noted above.
*
Your answer
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