Parental Consent and Release Form
Minor Information
Full Name of Minor:
Date of Birth:
Address:
Parent/Guardian Information
Parent/Guardian Name:
Relationship to Minor:
Contact Number:
Consent and Release
Description of Activity/Event:
Additional Notes/Conditions:
Authorization
By signing below, I give consent for the above-named minor to participate in the described activity/event and release the organizers from liability as described.
Parent/Guardian Signature
Date
Printed Name