Date (MM/DD

)

Signed in at (AM/PM)

Child’s Name (Please print)

Parent or Guardian’s Signature (Please use a pen only)

Signed out at (AM/PM)

Parent/Guardian Initials

Care-A-Lot Center 417 North Spring Street #1 Murfreesboro, TN 37130 615-631-2636

1

TN 37130 615-631-2636 2 .Date (MM/DD) Signed in at (AM/PM) Child’s Name (Please print) Parent or Guardian’s Signature (Please use a pen only) Signed out at (AM/PM) Parent/Guardian Initials Care-A-Lot Center 417 North Spring Street #1 Murfreesboro.

TN 37130 615-631-2636 3 .Care-A-Lot Center 417 North Spring Street #1 Murfreesboro.

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