Youth Activity Participation Permission Slip
Participant Information
Name of Participant
Age
Address
Parent/Guardian Information
Parent/Guardian Name
Phone Number
Email
Activity Information
Activity Name
Date
Location
Medical Information
Medical Conditions (if any)
Allergies (if any)
Emergency Contact Name & Phone
Permission & Agreement
I, the undersigned parent/guardian, give permission for my child to participate in the activity listed above and release the organizers from liability.
Parent/Guardian Signature
Date