Teen Social Activity Permission Form

Teen Social Activity Permission Form
Please complete this form to grant permission for your teen to participate in the specified social activity.
Teen's Full Name*
First NameLast Name
Teen's Date of Birth*
MonthDayYear
Date
Teen's Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Full Name*
First NameLast Name
Parent/Guardian Relationship to Teen*
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address*
example@example.com
Emergency Contact Name (other than parent/guardian)*
First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Activity/Event Name*
Activity/Event Date*
MonthDayYear
Date
Activity/Event Location*
Does the teen have any allergies, medical conditions, or special needs? If yes, please specify.
Is anyone other than the parent/guardian authorized to pick up the teen? If yes, please provide their name(s) and relationship.
Parent/Guardian Signature*
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