P4P Health & Safety Release Form
I give the below named performer permission to participate in Perform 4 Purpose programs and affirm that I am a legal guardian of the same. I agree to maintain responsibility/liability for the below named performer throughout the duration of camp activities. Further, in the event that an emergency should occur, I grant permission for the program staff to seek medical care and/or hospitalization as they deem necessary.
Performer's Name *
Your answer
Allergies or other medical conditions *
Your answer
Parent/Guardian's Name *
Your answer
Parent/Guardian's Phone *
Your answer
Emergency Contact *
Your answer
Emergency Contact's Phone *
Your answer
Signature of Parent/Guardian *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
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