PARENT OR GUARDIAN’S PERMISSION TO PARTICIPATE

I, _____________________________________ (print your name), give my permission for, ____________________________________, a minor, (“Minor”) to participate in this event, entitled, ___________________________, at ___________________________ (print name of center). I have included my telephone number in case of emergency, as well as an emergency contact person and their phone number if I cannot be reached. Parent or Guardian Name: _________________________________

Parent or Guardian Signature: _________________________________

Parent or Guardian Phone Number: _________________________________

Date of Signature: _________________________________

Emergency Contact/Phone: ________________________________________________