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321 Empowerment Parent Permission Form
PARENT PERMISSION AND RESPONSIBILITY STATEMENT FOR STUDENT PARTICIPATION IN DISTRICT AND NON-DISTRICT SPONSORED CLUBS, EVENTS, AND ACTIVITIES
Please include contact email address for the student.
* Indicates required question
Student Name
*
Your answer
Student Address
Your answer
Student High School
Your answer
Student Phone Number
Your answer
Career Interest
Your answer
What clubs, activities, or sports are you a part of?
Your answer
How many adults live in your household?
Your answer
How many people currently live in your household, including yourself?
*
Your answer
Parent Name
*
Your answer
Parent Phone number
Your answer
Parent Email
Your answer
Do you give 321empowerment permission to use your image for Media and Marketing
Yes
No
Clear selection
Do you give 321empowerment permission to connect your child to a mentor that has been fully background checked?
Yes
No
Clear selection
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