BROTHER TO BROTHER PERMISSION SLIP

BROTHER TO BROTHER MENTORING PROGRAM

Parental/Guardian Permission Form
NOTE: Please fill out and return this form by hitting SUBMIT button below. Your child will not be allowed to attend this event without returning this completed form.
Your child will be attending:
Boxing Event (Legacy Boxing Club), Boat House in Woodland Park, NJ.
Date

Month Day Year
Parents are requested to have their child at 11 Pine Street, Montclair by 12:30 pm.
Parents are requested to pick up their child from 11 Pine Street, Montclair, NJ no later than 3:30 pm.
COST: FREE. Refreshments will be sold at the event. Please provide your child(ren) with money for refreshments.

Masks will be required.

Should you have any questions about this field trip please contact Executive Director, Joe Davis at 201 306 1518.
NOTE: PLEASE COMPLETE A PERMISSION SLIP FOR EACH CHILD WHEN MULTIPLE CHILDREN ARE ATTENDING.
This is to certify that I give permission for my child
Child's Name *

First Name Last Name
To attend the field trip noted above.

In case of an emergency, I give permission for my child to receive medical treatment. In case of such an emergency, please contact:
Emergency Contact Person *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Parent / Guardian Name *

First Name Last Name
Parent / Guardian Phone Number *

Area Code Phone Number
Parent / Guardian Signature (please type) *
Parent's Email *
example@example.com
Should be Empty: