PARENT CONSENT FORM

NAME:____________________________        BIRTHDAY:______________________        AGE:________

ADDRESS:________________________        HOME PHONE:___________________        CELL PHONE:______________________
__________________________________                
__________________________________                

FOR DRIVERS:                
D.L.#:______________________________                
S.S.#:______________________________                


EMERGENCY CONTACT NAME:______________________________________        HOME PHONE:_____________________

RELATIONSHIP:____________________                CELL PHONE:______________________

ADDRESS:_________________________                WORK:____________________________
___________________________________                
___________________________________                


MAJOR MEDICAL CONDITIONS:______________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
MEDICATIONS TAKEN REGULARLY:_________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ANY ALLERGIES:___________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

PARENT/GUARDIAN SIGNATURE
(Employees Under 18)_________________________________________________________________________________________
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