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Youth Parent Permission Form
Please submit a form for each of your youth(s), grades 6th-12th.
Please note that this form only needs to be submitted
ONCE
to cover all activities with Youth for the entire school year.
Questions? Contact Emily Berry:
emilycberry@gmail.com
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Child's full name:
(First, Middle, Last)
Your answer
Preferred name, if different from above:
Your answer
Child's preferred pronouns:
She/her/hers
He/him/his
They/them/theirs
Other
Clear selection
Date of birth:
MM
/
DD
/
YYYY
Name of school:
Your answer
Current grade:
Choose
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Child's phone number, if applicable:
Your answer
T-shirt size:
Choose
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Food allergies and dietary restrictions:
Your answer
Other allergies & important health information:
[include any activity restrictions]
Your answer
Medications:
No, my child will NOT need to take medication.
Yes, my child WILL need to take medication.
My child MIGHT need to take medication. (Explain below)
Clear selection
If you selected your child "might" need medication above, please expound:
Your answer
Over-the-counter medications:
No. Contact me or seek medical help if my child has any medical concerns prior to providing any treatment.
Yes. I give permission for my child to have FDA approved over-the-counter medications as directed (i.e. Tylenol, Advil, antacids, Benadryl) as needed.
Clear selection
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