JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Teen Time Family Game Nights at the Virgin Islands Children's Museum
Registration Form
Sign in to Google
to save your progress.
Learn more
Guardian's Name
Your answer
Guardian E-Mail Address
Your answer
Guardian Phone Number
Your answer
Alternate Emergency Contact Name
Your answer
Alternate Emergency Contact Phone Number
Your answer
Adolescent's Name(s)
Your answer
Adolescent's Age(s)
Your answer
Name of the School Adolescent Attends
Your answer
Parent or Guardian Will Attend
Always
Sometimes
Never
Clear selection
Dietary Restrictions of Youth and/or Chaperone
Your answer
Other Information You Think We Should Be Aware Of
Your answer
I am the parent and/or legal guardian of the minor listed above, and
I give my permission for the adolescent listed above to attend Teen Time game nights at the Virgin Islands Children’s Museum located in Buccaneer Mall, Havensight, St Thomas. On behalf of said minor, I hereby release VICM and its partners from any liability for illness, injury or medical expenses sustained by said minor while attending Teen Time at the VICM. I understand it is my responsibility as parent/guardian to arrange transportation to and from the museum for the Teen Time game nights.
In checking the box below, I grant my permission for the youth listed above to participate in this valuable educational experience.
It also indicates that said youth can be photographed for grant reporting and promotional purposes.
I hereby grant permission
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Virgin Islands Children's Museum.
Report Abuse
Forms
