Sample: Parental Permission Slip
Article Specs |
Article ID: 2070
Age Group: Adult
Days Up: 5,942
Times Read: 27,301
Posted: November 29th. 1997
Times Viewed: 27,301
Teachers can use this form as a guideline for use when accepting minor students into a class or other teaching event. The teacher may also want to include copies of class materials when sending this form to the parents or guardian.
Do note that if athames will be used by minor students during an event that extreme caution is advised. Double edged blades are still considered illegal in most states and special liabilities may be incurred by their use. Parental permission cannot cover or absolve involvement in any legally restricted activity. Check with your local police department.
__________________ requests permission for your minor child _________________________
to participate in the teaching/class/workshop described below:
Date and Time:__________________________
Location________________________________ Phone Number:_______________________
Description of Teaching/class/workshop:
Date of Birth:__________________________________________________
Name of Parent or Guardian:________________________________________
Home Phone:_____________________Work Phone:____________________
Relationship to Student:___________________________________________
IN CASE OF EMERGENCY:
I/We make every effort to provide a safe and secure environment for your child during teaching/class/workshop events. In order to better to protect the safety and health of your child, I/we request that you provide the following information:
In case of an emergency, I/We will contact the parent listed above. I/We request that the parent provide another contact (not living at the same address) who is authorized by the parent to act on his/her behalf should the parent not be available.
Emergency contact: Name:___________________________________________________
Relationship to Parent/Student:_________________________________
PLEASE INDICATE on the back of this notice: Please list any health conditions, allergies or diet/mental/physical restrictions that your child may have and medications that he/she may be using to treat this condition. Indicate if the child has your permission to take such medication while attending the event. You may also include the name of the hospital or doctor of your choice and their phone numbers.
Also if you have made arrangements to have a person other than yourself provide transportation to and from this event, please indicate the name and phone number of such person.
During this teaching/class. workshop, the following materials may be used:
Incense ____ Candles ____ Herbs ____< Oils ____ Other __________________
My son/daughter ______________________________ has permission to participate in (Name of teaching/class/workshop) _______________________________ on (Date of Activity)___________________________. Date of his/her last tetanus shot ________. He/She is allergic to _________________________ and I have noted his/her physical limitations on the back of this form. During the activity, I may be reached at: Address _______________________________ Phone _______________ If I cannot be reached in the event of an emergency, the following person is authorized to act in my behalf:
Name and Address _________________________________________________________
Relation to participant ______________________ Phone___________________
Additional Remarks _______________________________________________________
(Parent's Signature) (Date)
By signing this form, I declare that I am the legal parent/guardian of the minor child listed above and authorized to grant such permission.
Location: Tampa, Florida
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