Guardian

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Phone *

Parent/Guardian City *

Parent/Guardian Address *

Parent/Guardian State *

Parent/Guardian Postal code *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Student

Student First & Last Name *

Relationship to the Parent/Guardian *

Grade Entering *

School Attending *

Date of Birth *

Student Phone Number

Participation Agreement *

Yes

By the parent or legal guardian above allows the above student to participate in the activities of Boys 2 Men

Medical

Does your student have allergies? *

Yes

If Yes, please explain

Does your student take medication?

Yes

If Yes, please list

Medical Insurance Company

Medical Insurance Policy Number

Name of Parent or Legal Guardian Consenting to Medical Treatment

Do you consent?

Yes

Activity Waiver

Name of Parent or Legal Guardian Consenting to the Activity Waiver

Do you consent?

Yes