I __________________________________ give my

 

child __________________ permission to attend the

 

FAME event: ____________________________

 

Date:_____________________________

 

 

_________________________________                                                                                                                                         Signature of Parent/Guardian

 

Emergency Contact

 

Phone Number__________________________

 

Name:________________________________

 

Relation To Patron:_________________________

 

                                 

For additional information please contact Hicksville Community Service Center at 419.542.7173

 

All participants must have a written permission slip to participate

 

 

FAME EVENT PERMISSION SLIP

 

Complete this permission slip and have child bring to event