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First Name(Required)

Last Name(Required)

Email(Required)

Phone

Date(Required)

In connection with and consideration of my child participation in the Community Bridging Project Forum, I, the parent/guarding of the child identified above, hereby represent and agree as follows:

I understand that my child will be participating in the Community Bridging Project (CBP) Forum and related activities, and I hereby give permission for him/her to participate in that capacity.
I confirm that my child is autonomous enough to participate in the CBP Forum. CBP Forum activities may include, but not limited to, online posting activities, meetings, workshops, or conferences.
I authorize CommuBridge to publish or release to the media any pictures of my child during his/her time as a participant for promotional or recognition purposes only.
Please check box if you DO NOT consent to this statement. This box, if left unchecked, means that you DO consent to any publications or media release.
I, the undersigned, certify that I am the parent and legal guardian of the child (named above).

Parent/Guardian’s Full Name

Parent Guardian’s Contact Email

DISCLAIMER: By typing your name above, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this parental consent form.

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