Parent Consent Form

BMMU Activity and Field Trip Addendum Form

Black Muslim Men United for a Better Philadelphia Activity & Field Trip Addendum Form Please complete this addendum to authorize your child's participation in the specific event detailed below.

Participant First Name

Participant Last Name

Parent/Guardian First Name

Parent/Guardian Last Name

Activity / Trip Name

Activity / Trip Date

Destination

Destination Address/Location

Address Line 1

Address Line 2

City

State

Zip Code

Country

Departure Time

Expected Return Time

Departure/Return Location

Transportation Method

Cost (if any)

Addendum Due Date

Meals / Refreshments

BMMU Event Contact Name

What Participants Should Bring / Wear

Special Instructions

Parent/Legal Guardian Authorization

I hereby authorize my child to participate in the activity/trip detailed above under the terms, liability waivers, and conditions set forth in the BMMU Master Youth Registration Form.

Has any information on the Master Form changed?

Yes

If Yes, please explain the change(s):

Accuracy Confirmation

I confirm that all other information contained in my child's Master Form remains accurate and up-to-date.

Digital Signature

I provide my digital signature and confirm that I am the legal parent/guardian of the participant named above.

Date

Parent Consent Form

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