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2023 EASTSIDE YOUTH PARENT CONSENT, PHOTO RELEASE AND MEDICAL AUTHORIZATION FORM
This form grants consent to participate in Eastside youth events/activities as well as provides authorization for medical treatment if needed.
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* Indicates required question
Email
*
Your email
Students Name
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Student's Email (optional)
Your answer
Student's Phone Number (optional)
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Emergency Contact Name:
*
Your answer
Emergency Contact Phone Number
*
Your answer
Relationship to Student
Your answer
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