Middle School Meet Up Registration

Student Name *

Emergency Contact Name *

Emergency Contact Phone Number *

Any allergies we should be aware of? *

I give the above mentioned child permission to attend the "Middle School Meet Up" on 12/21/21. I give consent for the leaders of the event (presented by "New Thing") to obtain through a physician of their choice, such medical care as may be reasonably necessary for the welfare of my child. *

Yes

No

Required