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25-26 [add date] Permission Slip

EVENT NAME & EVENT LOCATION

STUDENT FIRST NAME

STUDENT LAST NAME

STUDENT SCHOOL

STUDENT SCHOOL
A
B
C
D
E
F
G
H
I
J
K
L

STUDENT GRADE

STUDENT GRADE
A
B
C
D
E
F
G

PARENT/GUARDIAN NAME

PARENT/GUARDIAN EMAIL

PARENT/GUARDIAN PHONE

Does TRIO Talent Search have permission to text this number?

Does TRIO Talent Search have permission to text this number?
A
B

EMERGENCY CONTACTS

 I understand that should a medical problem arise, an attempt will be made to notify me or the following emergency contacts.
Emergency Contact 1
Emergency Contact 2

PHOTO PERMISSION

Your child may be photographed in conjunction with Talent Search events. Talent Search may use the photographs along with your child's name in publicity articles such as the Talent Search newsletter, local newspapers, or website.
PHOTO PERMISSION
A
B

TRANSPORTATION

I will drop-off my child at
TRANSPORTATION - dropoff location
A
B
C
I will pick-up my child at
TRANSPORTATION - pickup location
A
B
C

MEDICAL RELEASE SECTION

Does student have health insurance?
HEALTH INSURANCE
A
B
Name of health insurance provider
Emergency Medical Permission (choose one option):
EMERGENCY MEDICAL PERMISSION
A
B
Over-The-Counter Medicine - I give permission for my child to receive the following OTC medicines:
OTC MEDICATIONS PERMITTED
Dietary Restrictions
Is there any confidential medical information that might impact the student's learning or participation?
CONFIDENTIAL MEDICAL INFORMATION
A
B