TEAMup Event Permission Form

TEAMup Permission Form & RSVP

PARENT FORM
What: TEAMup Hot Cocoa Bar Holiday Gathering

When: Saturday, Dec. 7, 2024

Drop Off: 1:00 pm, Pick-Up: 3:00 pm

Location: The Agility Center
Has your therapist recommended this gathering for your child?*

YesNo (Please speak to your therapist first as participation is subject to therapist availability.)
Supervising Therapist First and Last Name*
I give permission for my child to attend this TEAMup gathering.*

YES, I give my permission.
Name of client: *

First NameLast Name
Emergency Contact Name & Phone Number*
Food allergies or other concerns we need to be aware of during the gathering?*
SOCIAL MEDIA WAIVER: I give authorization to photograph/video for promotional use. Children's Therapy TEAM has the right and privilege to photograph/video my child for the use of developing and publicly releasing promotional information. I understand that my child's image may be viewed in the form of social media, magazines, picture slideshows, posters, television, commercials and/or electronic media.*

YesNo
Parent Name*
Parent Signature*

Clear
Should be Empty:

TEAMup Permission Form & RSVP