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Pick Up List
Pick Up List
Pick Up List
Missy Monsivais
2279 South 2000 West
Syracuse, Utah 84075
(801)-775-0369
Only those who are on this list will be permitted to pick your child up. They must show photo
Please do not bring your child if he/she has any of the following symptoms; Sore Throat,
Fever, Swollen Glands, Diarrhea, Ear Infection, Vomiting, Eye Infection, Hard Coughing, Runny Nose
(green). If your child becomes ill after arriving you will be notified immediately and you will need to
pick him/her up as soon as possible. The child may not return until well or accompanied by a doctor’s
note. This is a State of Utah Health Department rule. These rules are for the protection of your child
and the others in my care.
Please list any individuals approved to pick up your child. These individuals will be called as
emergency contacts also if the parent or guardian is unavailable unless specified otherwise.
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I agree to inform the provider immediately of any illness, fever, or contagious disease that my
child may have or has been in contact with, and pick my child up if they are running a fever or ill.
Signature of Parent/Guardian__________________________________________