Day Care Authorization

I, the undersigned parent, Alex R. Olsen of 123 Main St., Mill Valley, California 94941 and Sandy's Day Care, the undersigned child care provider of 35 Palm Circle Dr., Corte Madera, California 95422, agree to the following terms regarding the child care of Kyle F. Olsen. The days and hours that Sandy's Day Care will provide care are Monday through Friday from 8:00 AM to 5:00 PM. Contact Information: Name: Alex R. Olsen Relationship: Father Place of Employment: Olsen Steel Company, Inc Home Phone Number: (415) 344-1234 Work Phone Number: (415) 634-1443 Mobile Phone or Beeper: (415) 440-5567 If the parent cannot be reached, contact: Name: Address: Phone Number: Relationship to child(ren): Dorian Mayhew Rothschild 60 Arthur St. San Rafael, CA 94901 (415) 445-6013 Uncle

In addition, I grant permission of the following: * participation by my child(ren) in field trips via walking or riding in the day care provider's vehicle. * seeking emergency medical treatment for my child(ren).

Parent:

____________________________________________ Alex R. Olsen

Date: April 24, 2012

© This is a RocketLawyer.com Legal Document ©

Child Care Provider:

____________________________________________ Sandy's Day Care

Date: April 24, 2012

© This is a RocketLawyer.com Legal Document ©

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