Youth Literacy Program Guardian Consent Form

Youth Literacy Program Guardian Consent Form
Please complete this form to provide your consent for your child’s participation in the Youth Literacy Program.
Participant’s Full Name
First NameLast Name
Participant’s Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Guardian’s Full Name
First NameLast Name
Guardian’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Guardian’s Email Address
example@example.com
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Guardian’s Signature
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Should be Empty: