Community of Hope activities agreement, medical and legal release form for students.
Effective June 1, 2017 through June 1, 2018 Please fill out the following information
STUDENT INFORMATION
Student's Name *
Student's Name
Birth Date *
Birth Date
CONTACT INFORMATION
Mother's Name *
Mother's Name
Father's Name *
Father's Name
MEDICAL INFORMATION
If "no", mark N/A.
If "no", mark N/A.
LEGAL RELEASE FORM
Type Student's Name
Date: *
Date:
Legal guardians may sign here. Please type name(s).
Date *
Date