Parent/Guardian Permission Form "*" indicates required fields Student Name* First Last HiddenSchool Denny Middle School Meany Middle School Other School Name* Has the Scholar participated in the program before? Yes! (Application is Not Required) No, I’m New! Application is Required) Parent/Guardian Name* First Last Parent/Guardian Phone*Parent/Guardian Email* Please Select a Program 4C Virtual Monday Group Mentoring One-On-One Mentoring Consent*By selecting the “Yes” checkbox you are giving consent for your child to participate in the program.. Yes Image Release*I also give permission for a portion of my students recordings and or picture to beshared on social media or for promotional purposes. Yes No Parent/Guardian Signature*Signature Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
