BROTHER TO BROTHER PERMISSION SLIP

BROTHER TO BROTHER MENTORING PROGRAM

Parental/Guardian Permission Form
Parents/Guardians: Please note that our insurance policy, which we are required to carry, covers your student(s) during all activities at 11 Pine Sreet, Montclair, NJ, and during any offsite events. However, in order for your student to be covered, and our organization to be protected, they must have a current application on file. One is required at the beginning of each school year.

If you have not done so yet, please go to this link to complete an application now: BROTHER TO BROTHER / LITTLE BROTHER TO BROTHER MENTORING APPLICATION FORM (jotform.com) before completing this permission slip.

We do not want to turn any student away from participating in Brother to Brother, however, we must adhere to our insurance guidelines.

Thank you for your understanding.

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:
Tennis instruction at Nishuane Park, Cedar Street, Montclair, NJ 07042. The lessons will be over 2 Saturdays.
Date

MonthDayYear
Date

MonthDayYear
Please plan to arrive by 10:00 am at Nishuane Park, Cedar Street, Montclair 07042.
Parents are requested to pick up their child from Nishuane, Montclair, NJ at 11:30 am.

Space is limited, so respond as soon as possible.

Rackets will be supplied.
COST: FREE.

TRANSPORTATION: By parent/guardian.

Should you have any questions about this field trip please contact Executive Director, Joe Davis, 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 NameLast 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 NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Parent / Guardian Name*

First NameLast Name
Parent / Guardian Phone Number*

Area CodePhone Number
Parent / Guardian Signature*

Clear
Parent's Email*
example@example.com
Should be Empty:

BROTHER TO BROTHER MENTORING PROGRAM