Beach Cleanup Permission Form 2019

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form confirms attendance of you and your child in the Ft. Lauderdale Beach Cleanup on March 9, 2019 from 9 until 11:30 AM. Address of meeting place: 300 S. Ft. Lauderdale Beach Blvd, Ft. Lauderdale, FL. Attire: t-shirt, pants and hat. Also bring: water, snacks, sunscreen, bug repellent.

Student Name *

Telephone Number *

Year Level *

1- 6th Grade

2- 7th Grade

3- 8th Grade

Other:

Emergency Contact Name 1 *

Emergency Contact Relationship 1 *

Emergency Contact Telephone Number 1 *

Emergency Contact Name 2

Emergency Contact Relationship 2

Emergency Contact Telephone Number 2

Health/Accident Insurance Company Name *

Insurance Policy Number *

Select one: *

My child is covered by twenty-four (24) hour student accident insurance or family insurance.

I do not have insurance; however, I will pay any and all medical bills for emergency care of my child.

Required

Selecting YES indicates your signature, your completion of this form and your acknowledgement that you will be staying with your child for the morning. *

YES

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms