Name: _________________________________ born on _______________________________
Social Security Number: _________________________________________________________
Address: _____________________________________________________________________
The undersigned(s) being the lawful parent(s) and/or guardian(s) of the above child (the “Child”), hereby consents to the participation by the Child in ___________________________ (describe activity) conducted by __________________________________________________ (Name of “Organizer”) and to the participation of the Child in all events relating to the activity on _______________________________ through ____________________________________.
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