Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Child's Name *FirstLastDate of Birth * Phone Please Layout Where to? *Sporting EventCultural EventCollege TourSix Flags (NO MORE TICKETS - SORRY)OtherParent/Guardian Name *FirstLastPreferred Phone *Email *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePreferred Method of ContactPhoneEmailWritten (mail)Medical Information: Please list allergies, medications, relevant medical conditions, and/or insurance info (optional, but helpful).I give permission for my child to attend the field trip stated above. I understand that transportation will be provided, and that my child must follow all rules and instructions given by staff. I release Friends and Mentors (FAM), its staff, volunteers, and affiliates from any liability in the event of injury, loss, or illness during this event. I understand that I am responsible for any medical expenses incurred.Parent/Guardian Signature * Clear Signature Submit
