TEEN NIGHT Permission Slip

BOYS & GIRLS CLUBS OF GARDEN GROVE

Event: TEEN NIGHT

Date: 10/17/25

Location (name & address):

Main Branch | 9860 Larson Ave, Garden Grove, CA 92844

Times: Parent Drop Off | Starts: 5:30 PM Ends: 8:00 PM

Cost: $0

Contact Name: Maria GM | Phone: 714-376-0974

Youth attending events with Boys & Girls Clubs of Garden Grove are expected to behave in a positive manner. Undesirable behavior will not be tolerated, and suspension from further outings will result.

My children First Name* Last Name* has permission to attend the event with Boys Girls Clubs of Garden Grove and Garden Grove Unified School District on the date noted above I will assume all responsibility for my children and release from liability all employees and agents of Boys Girls Clubs of Garden Grove and all other sponsoring organizations

In the event I cannot be reached in an emergency, I give permission to the physician selected by Boys & Girls Clubs of Garden Grove Director to hospitalize, secure proper treatment for, and make any necessary decisions regarding anesthesia or surgery for my child as named above. I hereby give my permission to the physician selected by Boys & Girls Clubs of Garden Grove to order x-rays, routine tests and treatment for the health of my child.

HOLD HARMLESS CLAUSE: I agree that Boys & Girls Clubs of Garden Grove, its Board of Directors, Officers, Staff and Garden Grove Unified School District including its Board of Directors, Officers, Staff and Volunteers are hereby relieved of all liability in the event of accident or injury to said minor.

ParentGuardian Signature*

Date*

Date

Phone Number*

Format: (000) 000-0000.

Known Allergies*

Please list two other emergency contacts to pick up your child:

Name*

Phone#*

Format: (000) 000-0000.

Relation to child*

Name*

Phone#*

Format: (000) 000-0000.

Relation to child*

Can photos be taken of your child (for publicity purposes)?*

YesNo

Permission Slip

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