Class 3 Consent Form
Please complete this form to provide consent for your child’s participation in Class 3 activities.
Student Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Class/Section
*
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the student have any medical conditions or allergies we should be aware of? If yes, please specify.
Signature of Parent/Guardian (to confirm consent)
*
Date of Consent
*
-
Month
-
Day
Year
Date
Submit Consent
Submit Consent
Should be Empty: