[text_content "I,"]

    [text_content "authorize Jeannie People's Child Care "]

    [text_content "to release my child(ren) to the person(s) designated. This is in consonance with Jeannie People's Family Child Care Emergency Operations Plan."]

    [text_content "NOTE: Parents and guardians should designate themselves as custodians. Friends, neighbors and other relatives may also be designated."]

    1: *Child's Name

    2: Second Child's Name

    3: Third Child's Name

    4: Fourth Child's Name

    5: Fourth Child's Name

    * List #’s from above that are allowed for each

    * Designated Custodian Name

    * Designated Custodian Relationship

    * Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    List #’s from above that are allowed for each

    Designated Custodian Name

    Designated Custodian Relationship

    Designated Custodian Phone Number

    * Your Signature

    * Relationship

    * Today's Date

    * Your Name

    * Address

    Address

    *Home Phone

    * Work Phone

    Cell Phone

    *Email