PPCLF

Parental Permission and Consent Form

* Indicates required field

Name of Student *

First

Last

Student's Birth Month *

Day *

Year *

Name of Parent/Guardian *

First

Last

Agreement *

I Agree that I am the legal guardian of said minor(s).

Event Name *

Start Date/Time *

End Date/Time *

Choose Any *

As legal Guardian of said minor i here by give permission for activity or event.

Please note the reasoning we ask for such information is for students safety and to maintain easily accessible communication with said parent(s)/guardian(s). Thank you for your patience and time!

Phone Number *

Emergency Contact *

First

Last

Emergency Contact # *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Allergies Drug/Food *

Asthma *

Yes No

Diabetes *

Yes No

Last Tetanus *

Agreement *

As legal guardian i here by consent to any hospital, medical, or surgical care and treatment, and administration of anesthesia. (determined by a qualified physician to be necessary for the welfare of said minor).

Submit