Fill in and print this release form. If necessary, please attach separate sheet(s).

Emergency Contact Information

Emergency Contact Information

Parent / Guardian 1:
Parent / Guardian 2:
Other than Parent / Guardian:
I give permission for my son/daughter to join JVL Summer School for Performing Arts in YMCA Geneva Park, Orillia, Canada, July 01 - 11, 2017. I give permission to the School Staff to authorize medical treatment for my son/daughter in case of emergency.
Name and signature of parent or guardian:
__________________________________________________________________________ Date ______________
cdc-mis