The Anchor After Dark Parent Permission and Release Form

The Anchor After Dark Parent Permission and Release Form

Complete this form to permit your student to attend the upcoming event. Review all details and provide necessary permissions below.
Date : Friday, October 30, 2026 Time: 6:30 pm –10:30 pm
Location: 110 7th Avenue, Helena, MT 59601
What to bring: Anything that glows in the dark
Dress code: Wear white or neon. Costumes welcome; no masks or replica weapons.
Lead adult/phone: Derek Calvert, 406-800-1210
Student Full Name

First NameLast Name
Student Grade
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact During the Event (if different)

First NameLast Name
Emergency Contact Phone (if different)
Please enter a valid phone number.Format: (000) 000-0000.
May your student leave the event on their own?
Adults authorized to pick up my student
Medical conditions, allergies, or medications
Permission to obtain emergency medical care if parent/guardian cannot be reached
Permission to use photos or video of my student from this event in newsletters, website, and social media
Parent/Guardian Name (Print)

First NameLast Name
Parent/Guardian Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: