Book Club Permission Form
Please fill out this form to give permission for your child to join the book club.
Parent/Guardian Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
First Name
Last Name
Child's Grade Level
Medical Information (if applicable)
Medical Conditions/Allergies & Current Medications
Emergency Contact Information
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Permission Granted
I, the undersigned, grant permission for my child to participate in the Book Club organized by the School.
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: