High-Risk Activity Permission Form I,This field is hidden when viewing the formII,Name (Parent/Guardian's Name)(Required) First Last the parent/guardian ofThis field is hidden when viewing the formthe parent/guardian ofthe parent/guardian ofName (Child's Name)(Required) First Last give permission for my child to participate in the following high-risk activity with their mentor:This field is hidden when viewing the formgive permission for my child to participate in the following high-risk activity with their mentor:give permission for my child to participate in the following high-risk activity with their mentor:Age of child(Required)Activity(Required)Date of activity(Required) MM slash DD slash YYYY Time of activity(Required)Location of activity(Required)Will qualified personnel be present (lifeguard, etc)(Required)The following safety equipment and precautions will be in place:(Required)Signature of Parent / Guardian(Required)Date(Required) MM slash DD slash YYYY SMS Verification This field is hidden when viewing the formFooterMatches may request to engage in a Permitted High-Risk Activity and submit this permission form directly to their Mentoring Coordinator each and every time they wish to engage in this activity. Matches must receive permission from their Mentoring Coordinator to engage in the above activity. Approval for the match to engage in a High-Risk Activity is at the discretion of the agency.Matches may request to engage in a Permitted High-Risk Activity and submit this permission form directly to their Mentoring Coordinator each and every time they wish to engage in this activity. Matches must receive permission from their Mentoring Coordinator to engage in the above activity. Approval for the match to engage in a High-Risk Activity is at the discretion of the agency Share: Facebook Google+ LinkedIn
