After-School Program Parent Consent Form
Student Information
Full Name
Grade
Date of Birth
Parent/Guardian Information
Full Name
Phone Number
Email Address
Emergency Contact
Contact Name
Relationship
Phone Number
Medical Information
Allergies/Medical Conditions
Consent and Permissions
I give permission for my child to participate in the after-school program
I authorize emergency medical treatment for my child if necessary
I consent to the use of photos/videos of my child for program purposes
Parent/Guardian Signature
Date