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Transportation Plan and Authorization

MY CHILD WILL ARRIVE AT THE PROGRAM:

MY CHILD WILL DEPART FROM THE PROGRAM:

Program Arrival
PROGRAM DROP OFF

If you have selected other please list below or the school must be notified of alternate transportation on any specific school day if necessary.

Mansfield Little School Carpool

Mr. or Mrs.

Mr. or Mrs.

OR:

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Date
Month
Day
Year

REFER TO FIRST AID AND EMERGENCY MEDICAL CARE CONSENT FORM FOR RELEASE INFORMATION

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