Parent Consent Form

Parent Consent Form
Parent/Guardian Information
Parent/Guardian Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Student Information
Student Name:

First NameLast Name
Student I.D. #
Date of Birth

MonthDayYear
Date
Grade
School

SussmanDotyGriffithStaufferOther
Questions/Concerns
Consent Acknowledgement
As the parent/guardian, I understand that I am giving consent for the offices of the 10-20 Club to contact/call me to provide more information about the Decision Making Sessions.

Como padre/tutor, entiendo que estoy dando mi consentimiento para que el Club 10-20 se comunique conmigo para proporcionar más información sobre las Sesiones de Toma de Decisiones.
Signature

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As the parent/guardian, I give permission for my child to attend the 10-20 Club programs.

Como padre/tutor, doy permiso para que mi hijo/a asista a los programas del Club 10-20.
Signature

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Should be Empty:

Parent/Guardian Information