Free Permission Slip 12
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Participant Name:
____________________________________________________________________________________
I give permission for my child (named above) to attend the
_________________________________________on __________________________________ from
________________________. The activities that will be taught will be used
_______________________________________.

__________________________________

________________________

Signature of Parent or Legal Guardian

Printed name of Parent or Guardian

________________
Date

EMERGENCY CONTACT INFORMATION
Parent(s)/Guardian(s)

Phone Numbers

Name(s)

Street Address

City

State

Zip

Parent(s)/Guardian(s) Email address(es)
Best Email address(es) to reach Parent(s)/ Guardian(s)

Phone Type
(Home, Mobile, etc.)