Permission

Dr. Darryl’s Gospel Sing

(April 17, 2023)

Please fill the form below:

STUDENT INFORMATION

Phone for Emergency

First Name

Last Name

Student's Email

Student's Age

PARENT/CAREGIVER CONTACT

Name of Guardian

First Name

Last Name

Relationship to Singer

Email

Cell Phone

(###)

###

####

PERMISSIONS

I confirm that I am the parent/legal guardian of the student above:

I give permission for my child to attend Dr. Darryl’s Gospel Sing on April 17th 7 pm. I give permission for my child's photo/video taken during Singers' Workshops activities to be used in publication produced and distributed by the Singers' Workshops at Teachers College, Columbia University:

Yes

No

In a medical emergency, please list a contact person:

Phone

(###)

###

####

Do you give us permission to treat your child in the event of a medical emergency?

Yes

No

ELECTRONIC SIGNATURE

Parent Name and Date (MM/DD/YYYY)

Note: Under 16 you must be escorted from the front desk to the workshop. For those under 16, please either arrive with a chaperone or wait to be escorted with an approved chaperone.