8th Grade Celebration - Contact/Medical Info

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Please complete this short form to ensure the safety and security of all students attending the 8th Grade Celebration. Thank you in advance for your cooperation. Please forward questions to: Dawn Zavalishin, AMS PTO President at zavalishind8@gmail.com.

1. Student First and Last Name *

2. Parent/Legal Guardian First and Last Name *

3. Best Contact Number - June 3rd from 6pm - 11pm *

Please confirm the first and last name of individual(s) allowed to pick up your child upon completion of the event (please note: child will NOT be released if individual is not on approved list below): *

4. Please acknowledge that Avon Middle School PTO Personnel may seek emergency medical treatment in the event of an emergency involving your child. *

Yes

Other:

5. As food will be served at the event, please list any food allergies or special considerations:

6. Please provide any other pertinent information to ensure your child's safety during this event:

Please provide your typed signature which will serve as acknowledgement that you are the legal parent/guardian of student listed above and have responded to #4 (seeking medical treatment) and confirm your response. *

Submit

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