Extracurricular Club Parent Consent Form
Student Information
Student Name
Grade
Club Name
Parent/Guardian Information
Parent/Guardian Name
Relationship to Student
Contact Phone
Contact Email
Medical Information
Allergies or Medical Conditions
Emergency Contact Name & Number
Consent
I give permission for my child to participate in the above club. I acknowledge that I have provided all relevant medical information, and agree to the club's policies.
Parent/Guardian Signature
Date