Instructors in Paganism can use this form as a guideline for use when accepting minor students into a class or other teaching event. The instructor may also want to include copies of instruction materials when sending this form to the parents or guardian.
Do note that if athames will be used by minor students during an event that extreme caution is advised. Double edged blades are still considered illegal in most states and special liabilities may be incurred by their use. Parental permission cannot cover or absolve involvement in any illegal activity. Check with your local police department.
Well, here it is:
_______________________ requests permission for your minor child _________________________ to participate in the Pagan instruction described below: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ _____________________________________________________ Beginning:__________________________ Location________________________________ Phone Number:_______________________ Instructors Information: Instructor's name:______________________________________________ Phone number:______________________________________________ Contact Address______________________________________________ References:_________________________________________________ Student Information: Name:______________________________________________________ Address:_____________________________________________________ Phone number:________________________________________________ Date of Birth:__________________________________________________ Parental Information: Name of Parent or Guardian:________________________________________ Address:______________________________________________________ Home Phone: _____________________Work Phone:____________________ Relationship to Student:___________________________________________ IN CASE OF EMERGENCY: I/We make every effort to provide a safe and secure environment for your child during classes/workshop events. In order to better to protect the safety and health of your child, I/we request that you provide the following information: In case of an emergency, I/We will contact the parent listed above. I/We request that the parent provide another contact (not living at the same address) who is authorized by the parent to act on his/her behalf should the parent not be available. Emergency contact: Name:___________________________________________________ Address:__________________________________________________ Phone Number:____________________________________________ Relationship to Parent/Student:_________________________________ PLEASE INDICATE on the back of this notice: Any health conditions, allergies or diet/mental/physical restrictions that your child may have and medications that he/she may be using to treat this condition. Indicate if the child has your permission to take such medication while attending instruction sessions. You may also include the name of the hospital or doctor of your choice and their phone numbers. Also if you have made arrangements to have a person other than yourself provide transportation to and from this event, please indicate the name and phone number of such person. During these instruction sessions, the following materials may be used: Incense ____ Candles ____ Herbs ____Oils ____ Other __________________ Permission Notice: My son/daughter ______________________________ has permission to participate in Pagan Instruction classes on (Dates of instruction)___________________________. Date of his/her last tetanus shot ________. He/She is allergic to _________________________ and I have noted his/her physical limitations on the back of this form. During the activity, I may be reached at: Address _______________________________ Phone _______________ If I cannot be reached in the event of an emergency, the following person is authorized to act in my behalf: Name and Address _________________________________________________________ Relation to participant ______________________ Phone___________________ Additional Remarks _______________________________________________________ ________________________________________________ ___________ (Parent/Legal Guardian's Signature) (Date) By signing this form, I declare that I am the legal parent/guardian of the minor child listed above and authorized to grant such permission.
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