Sign the Minor Permission FormVIEW THE FULL FORM "*" indicates required fields Minor's First Name* Minor's Last Name* Minor's Birth Year*1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019Parent/Guardian First Name* Parent/Guardian Last Name* Parent/Guardian Birth Year*1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019Parent/Guardian Email* Campaign City*Campaign CityAllentown, PAAmerican Fork, UTAnn Arbor, MIBanks, ORChapel Hill, NCChicago, ILCincinnati, OHClifton Park, NYColumbia, MOCumming, GADenver, COFlossmoor, ILFort Worth, TXGreenville, SCHartford, CTIndianapolis, INJacksonville, FLKansas City, KSLas Vegas, NVLouisville, KYMiami, FLPhoenix, AZPortland, ORProsper, TXReno, NVRichmond, VARochester, NYRome, NYRoseville, MNSt. Louis, MOSt. Paul, MNTampa, FLWaldorf, MDWellington, COWinston Salem, NCMy Child is Allergic or Highly Sensitive to:*My Child Takes the Following Medications:*Emergency Contact Name:* Emergency Contact Phone*Consent* I agree and understand that by signing my name below that all electronic signatures are the legal equivalent of my manual/handwritten signature on the above Minor Permission Form and I consent to be legally bound to this agreement.Signature*CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
