PG-13 Movie Viewing Permission Form

Name of participant(s) *

Who will be attending the program? (List all attendees under age 13.)

Name of parent/guardian *

Those age 13 or below will not be able to attend without parent/guardian permission.

Date of program *

When is the movie being shown?

MM

/

DD

/

YYYY

By checking the boxes below, you are indicating your acceptance of the terms detailed on this form. *

I am the parent or legal guardian of the child/children named above;

I give my approval for the child/children listed to view the PG-13 rated movie being shown at the Altoona Public Library.

Required

Excellent! Let's get going!