Kotoricon - Parental Permission 2019
Submit the name and emergency phone number for this minor. Print out this form, complete it and bring an original signed copy to registration at Kotoricon. Kotoricon is held January 11/12 on the campus of Rowan College at Gloucester County in Sewell NJ. Our website has directions, policies and contact information at http://kotoricon.org All minors are required to attend Kotoricon with an adult, preferably a parent or guardian. In instances where another adult is bringing the minor, the minor must present a signed copy of this permission form to Registration. Minors under 18 can attend with this signed form when accompanied by a paid adult attendee.

Person other than parent or guardian responsible for this minor:

Name: ____________________________________________________________________

“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 : _______________________

Minor's Name *
Your answer
Emergency Contact Phone Number *
Your answer
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