Children Book Club Permission Form
Please fill out this form to give permission for your child to join the book club.
Date
-
Month
-
Day
Year
Date
Parent/Guardian Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
First Name
Last Name
Child Date of Birth
Name of School
Grade
Do you have computer with Internet?
No
Yes
Do you able to get on Zoom?
No
Yes
Permission Granted
I, the undersigned, grant permission for my child to participate in the Book Club organized by the Churches Outreach Network/ Interfaith Clergy. and I we help if needed.
I,grant permission for the use of individual and/or group photographs/video, involving my child In connection with Churches Outreach Network// Interfaith clergy and the Youth Coalition. For purposes of public relations and/or any media coverage of special events he/she may be photographed or videotaped. Any photograph, taping, or other illustrative material may be used without my examination of the finished product. I hereby waive my rights to privacy inconnection with consent above given, and I hereby release, discharge, and agreeto hold harmless all the parties to whom this consent is given from anyliability whatsoever.
Signature
Submit
Submit
Should be Empty: