A.C.T.S. YOUTH MINISTRY MOVIE NIGHT PERMISSION SLIP
Email address *
CHILD'S LAST NAME / APELLIDO DE SU HIJO/A *
CHILD'S FIRST NAME / PRIMER NOMBRE DE SU HIJO/A *
HOME PHONE / TELE DE CASA
CHILD'S CELL PHONE / CELL DE NIÑO/A
CHILD'S EMAIL/ CORREO ELETRONICO DE NIÑO/A
CHILD'S SCHOOL / ESCUELA DE NIÑO/A *
CHILD'S CURRENT GRADE /GRADO DE NIÑO/A *
DATE OF BIRTH / FECHA DE NACIMIENTO *
MM
/
DD
/
YYYY
ADDRESS / DOMICILIO *
FATHER'S LAST NAME / APELLIDO DE PAPA
FATHER'S FIRST NAME / PRIMER NOMBRE DE PAPA *
FATHER'S CELL PHONE/ NUMERO CEL DE PAPA
MOTHER'S LAST NAME / APELLIDO DE MAMA
MOTHER'S FIRST NAME/ PRIMER NOMBRE DE MAMA
MOTHER'S CELL PHONE/ NUMERO CEL DE MAMA
MOVIE NIGHT AT ST. RICHARD VOGEL HALL
1509 GRAND AVENUE
DATES OF ACTIVITY
FRIDAY APRIL 9
MODE OF TRANSPORTATION
YOUR OWN
DEPARTURE TIME
6:00PM
RETURN TIME
8:30PM
DESIGNATED SUPERVISOR
MR. ELOY 262-898-5666
STUDENT COST (IF APPLICABLE )
NONE
DOES YOUR CHILD HAVE ANY FOOD ALLERGIES? PLEASE LIST BELOW
PIZZA PREFERENCE *
MEDICAL INFORMATION AND RELEASE *
Required
IN CASE OF AN EMERGENCY
If are are unable to reach a parent/guardian at the above number, please contact:
EMERGENCY CONTACT / CONTACTO DE EMERGENCIA *
EMERGENCY CONTACT PHONE / TELEFONO *
AGREEMENT *
Required
PERMISSION *
Required
PHOTO RELEASE *
Required
COVID-19 FACE MASK *
Required
WHAT PARISH IS YOUR FAMILY REGISTERED TO? *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of ACTS Youth Ministry. Report Abuse