Parental Consent Form

I, (Parent/Guardian Name)* , as the legal parent/guardian of (Student Name)* , give permission for him/her/them to participate as a volunteer in the Jackson Symphony League’s Ambassador Program. I do not hold the League or The Jackson Symphony liable or responsible for any lost personal belongings or for any injury that may occur during his/her/their volunteer service or activity participation.

Yes No *
YesNo
YesNo
YesNo
Parent/Guardian Signature*

Clear
Click the box above to provide your digital signature.
Date of Submission*

MonthDayYear
Date
Photo Release Consent
YesNo
Health Information

This information is kept strictly confidential by the program administrator and is for the safety and well-being of the applicant.
Please list any allergies or medical conditions of student(s). If none, enter N/A.*
Emergency Contact Information
Parent/Guardian Name*

First NameLast Name
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Home Address*

Street Address

CityState

Zip Code
If parent/guardian is unavailable - please list two contacts
Emergency Contact Name*

First NameLast Name
Relationship to Student*
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name*

First NameLast Name
Relationship to Student*
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty:

Photo Release Consent

Health Information

Emergency Contact Information

If parent/guardian is unavailable - please list two contacts