Registration/Permission Form

Registration/Permission Form
Participant:
Age:
Parent's Name:
Address:
Email:
Phone Number:
Emergency Contact:
Session:
I give the Schreiber Public Library permission to take photos of myself or child(ren). These photos may be displayed at the Schreiber Public Library, in the local newspaper (Terrace Bay/Schreiber News) or on the internet ie. YouTube.
Permission
Parent's Name:
My child(ren)
List Allergies and Procedures
Should be Empty: