Parent-Teacher Initiative Consent Form
Please fill out this form to provide consent for your child to participate in the specified school initiative.
Student Full Name
*
First Name
Last Name
Student's Grade/Class
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
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.
Please specify the name of the initiative or program your child will participate in.
*
Emergency Contact Name (other than parent/guardian)
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have any allergies or medical conditions we should be aware of? Please specify.
Please select all permissions you grant for your child's participation in this initiative:
*
My child has permission to participate in this initiative.
I grant permission for my child to be photographed or recorded during the activity.
I allow my child to be transported by school-approved means if necessary.
Other (please specify)
By signing below, I confirm that I am the parent/legal guardian of the above-named student and give my consent for participation in the specified initiative. I acknowledge that I have read and understood the details of the program and grant the permissions indicated above.
*
Submit Consent
Submit Consent
Should be Empty: