Person other than parent or guardian responsible for this minor:
“I, as the adult responsible for this minor understand that I am responsible for the safety of the minor. The minor will not be left unattended and I will not leave the campus at any time while the minor is at KotoriCon.”
Signature of adult responsible: _______________________________________ Date: ____/____/________
By signing, the parent understands that we are not acting in place of a parent for the attending minor. Parent understands that they are responsible for the care, safety, and conduct of their child, whether or not they are attending with their child. Parent understands that the minor is expected to follow the convention policies, and the parent is solely responsible for policy violations on the part of the minor.
SIGNATURE (Parent or guardian): ____________________________________________________
Name (printed clearly):_____________________________________________________________________
Date: ____/____/____ PHONE : _______________________