Parental Consent Form No.:_______ Parental Consent Form No.

:_______

Name of Student Organization: _____________________________________________ Name of Student Organization: ______________________________________________

Name of Activity: _________________________________________________________ Name of Activity: _________________________________________________________

Nature of Activity: Co-Curricular Extra-Curricular Nature of Activity: Co-Curricular Extra-Curricular

Venue: __________________________ Inclusive Dates: _________________________ Venue: __________________________ Inclusive Dates: _________________________

I allow my son/daughter to attend the activity. I allow my son/daughter to attend the activity.
I trust that the organizers of this activity will take due diligence to ensure the safety of I trust that the organizers of this activity will take due diligence to ensure the safety of
my son/daughter as a participant. my son/daughter as a participant.

I do not allow my son/daughter to attend the activity. I do not allow my son/daughter to attend the activity.

Name of Student: _________________________________________________________ Name of Student: _________________________________________________________

Name of Parent/Guardian: __________________________________________________ Name of Parent/Guardian: __________________________________________________

Phone/Cell phone number: _________________________________________________ Phone/Cell phone number: _________________________________________________

Address: _______________________________________________________________ Address: _______________________________________________________________

Signature: ______________________________________________________________ Signature: ______________________________________________________________

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