School of Charm Health & Beauty Workshop
Student Permission Slip and Photo/ Video Waiver This form collects basic info about our student participant, their parent/guardian, as well as provides a waiver for recordings and scholarship photographs.
Parent /Guardian Name
First Name
Middle Name
Last Name
Parent/ Guardian Mobile Number
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Email
example@example.com
Students Name
First Name
Middle Name
Last Name
Student Date of Birth
-
Month
-
Day
Year
Date
Students Age
12
13
14
15
16
17
Preteen (9yr-11yrs)
Students Mobile Phone Number
Format: (000) 000-0000.
Students T-shirt size (shirts are in adult sizes)
S
M
L
XL
XXL
How did you hear about us?
*
Please tell us if a student referred you. We would love to thank them.
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Medical Information
Does the Student have Allergies including asthma?
*
Please explain on the field provided N/A if None
Food Allergies
Yes
No
Does student use inhaler or /And EpiPen
*
Please provide the details, the name of the medication and period of intake. Please Use N/A if this does not apply.
Can Student administration medication listed above on their own?
*
Yes
No
N/a
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Contact Information in Case of Emergency
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to Student
Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Relation to Student
How does Student get home
*
Walks
Public Transportation
Parent
Student is authorized to leave on their own and Pretty Minkss school of charm is not reliable after ending of workshop.
Workshop
*
Health & beauty Hygiene (9-12)
Health &Beauty Teen Makeup (13-17Only)
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Workshop
Total amount for chosen camps
I would like make a Donation
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( X )
USD
Description
Signature of applicant or guardian representative
I hereby give permission for images of my child, captured during Pretty Minks School of Charm Workshops through video, photo and digital camera, to be used solely for the purposes of _Pretty Minks School of Charm and or hired contractors __promotional material and publications on social media platforms website flyers billboards and waive any rights of compensation or ownership thereto.
YES
NO
Signature of applicant or guardian representative
Submit
Should be Empty: