Child Participant Registration and Consent Form
Participant Information
Child’s Full Name
Date of Birth
Gender
Female
Male
Non-binary
Other
School Name
Home Address
Parent/Guardian Information
Parent/Guardian Name
Relationship to Child
Primary Phone
Email Address
Emergency Contact
Name
Phone Number
Relationship
Medical Information
Does your child have any medical conditions, allergies, or special needs?
List any medications your child is currently taking
Permissions & Consents
I give permission for my child’s photograph/video to be used for nonprofit purposes.
In case of emergency, I authorize the organization to seek medical care for my child.
I give permission for my child to participate in all program activities.
Signature
Parent/Guardian Signature
Date