Volunteers under 18 years of age need to file an
Informed Consent & Release of Liability form

Please fill in the following form to complete the release:

VOLUNTEER'S DATA

PARENT'S/GUARDIAN'S DATA

Minor's First Name:

Minor's Last Name:

Address:

City:

State:

Zip:

Phone:

School:

Grade:

Sex

Parent's First Name:

Parent's Last Name:

Date of Event:

Name of Event:

Home Phone:

Work Phone:

Relationship

Insurance Company:

Ins Policy Number:

List any alergies
your child has

List any medications
your child must take
list dosage, frequency, etc.

List any special medical
condition or needs your child might have
include dietary, asthma, etc.