Student Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Do you grant us permission to administer Tylenol/Advil and/or minor first aid to your child in the event that it's needed? *

Yes

No

I would like more information

Do you grant us permission for the use of your child's image, voice, or work in various media, including our website, social media, and external media outlets? *

Yes

No

I would like more information