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Watertown Recreation Department

149 Main Street ● Watertown, MA 02472
Phone: 617-972-6494 ● Fax: 617-926-6129
recreation@watertown-ma.gov ● www.watertown-ma.gov

PEQUOSSETTE SUMMER RECREATION PROGRAM
APPROVED FOR PICKUP
We understand that from time to time primary guardians will need someone other than themselves to pick up their child
from camp. To better serve your family and to keep the safety of your child a priority, please provide us with the
information below for three individuals, who are not the primary guardians, you give permission to pick up your child.
When one of these individuals comes to pick up your child we will check their ID and that he or she is approved for pickup
before allowing your child to leave. If an individual is not approved for pickup, or if permission has not been
communicated with us either through note or phone call, you will be contacted via phone to give permission.

Child’s Name: _________________________________________ Age ______ Child’s Grade in Fall ’17: _____________

Address: _____________________________________________________ Telephone: _________________________

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Approved for Pickup #1

Name ___________________________________________________________________________________________

Relation to Camper ________________________________________________________________________________

Phone Number ___________________________________________________________________________________

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Approved for Pickup #2

Name ___________________________________________________________________________________________

Relation to Camper ________________________________________________________________________________

Phone Number ___________________________________________________________________________________

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Approved for Pickup #3

Name ___________________________________________________________________________________________

Relation to Camper ________________________________________________________________________________

Phone Number ___________________________________________________________________________________

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PARENT SIGNATURE

Parent’s Name: _____________________________ Parent’s Signature: ______________________________________