Minor Application Declaration and Guardian Consent Form
Complete this form to declare the minor's application and provide guardian consent for participation in the general program.
Minor's Full Name
*
First Name
Last Name
Minor's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Program or Activity Name
*
Minor's Declaration of Understanding and Willingness to Participate
*
Guardian's Full Name
*
First Name
Last Name
Relationship to Minor
*
Guardian's Email Address
*
example@example.com
Guardian's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian Consent Confirmation
*
I hereby consent to the minor's participation in the above program and confirm that I am authorized to provide this consent.
Guardian's Signature
*
Submit Consent
Submit Consent
Should be Empty: