MetaDAD Parent/Guardian Agreement

MetaDAD Parent/Guardian Agreement

Complete this agreement to provide required consents and information for the MetaDAD Program.
Child(ren) Name(s)
Participant (Father) Full Name

First NameLast Name
Father Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father Email Address
example@example.com
Parent/Guardian Full Name

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I have read and agree to the terms of this Parent/Guardian Agreement.
I have reviewed the MetaDAD Mentor & Mentee Guidebook and understand the program expectations.
I GRANT permission for my child to be photographed/recorded for MetaDAD promotional and research use.
I authorize emergency medical treatment if I cannot be reached.
My child agrees to follow the MetaDAD Code of Conduct.
Additional Notes or Special Needs (allergies, accommodations, etc.)
Participant (Father) Signature (if applicable)
Participant (Father) Signature Date

MonthDayYear
Date
Parent/Guardian Signature
Parent/Guardian Signature Date

MonthDayYear
Date
Should be Empty: