Dance Team Interstate Travel Permission Form

Team & Event Information

Dance Team Name
Event Name
Event Location (City, State)
Event Date(s)

Student Information

Student Name
Grade
Parent/Guardian Name

Permission & Emergency Contact

Emergency Contact Name
Relationship
Emergency Contact Phone
Additional Medical/Allergy Information
By signing below, I give permission for my child to travel out of state with the above Dance Team and its coaches/chaperones for the event listed above.
Parent/Guardian Signature
Date