TO PARTICIPATE IN THIS EVENT:

    *ALL MUST HAVE photo identification:

             driver’s license, STUDENT IDENTIFICATION

    *under 18 must ALSO have participant release information

PARTICIPANT RELEASE INFORMATION

I/We,_____________________________________________________, as the parent (s)/guardian (s) of _________________________________give our permission for him/her to attend a Chrysalis Hoot on ______________________time _________.    My child agrees to sign in and sign out of the event.

Name of responsible person to contact if neither parent/guardian can be reached in an emergency:

Name______________________________________ Phone______________________________

FOR ALL YOUTH UNDER 18

For the safety and protection of your child, please answer these questions.

1. Will the participant leave early?________________  If so, what time?________________

2. Name of person participant is to be released to (Detroit Conference recommends someone over 21)___________________________________

Parent/Guardian

PRINT name_________________________________ Phone _________________       

Signature of Parent/Guardian _____________________________________Date:____________

TO BE COMPLETED WHEN THE PARTICIPANT LEAVES:  NEED Picture Identification

_____________________________________ Time:________

Signature of person participant released to

Location of event:

Address:                                                                                   Phone: