Permission - Release and Consent Form
Weavers/ Mt. Clinton Mennonite Churches - Children (Good for 1 year)
Email address *
Participant's Information
Please provide the requested information in order to accurately care for your child.
Today's Date *
MM
/
DD
/
YYYY
Child's Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade Level (presently/completed) *
Your answer
Parent/ Guardian Names *
Your answer
Home Address *
Your answer
Phone Number *
Your answer
Another Emergency Contact: Name, Relationship, Phone Number *
Your answer
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