Performance Program Self-Release Form

Participants in PISE programs may be permitted to sign themselves in and out, provided they meet the minimum age requirement of 11 years. If a parent or guardian is unable to accompany their child for sign-in and/or sign-out, or wishes to grant permission for independent arrival and departure, please complete the form below.

Signee Information

First Name *

Last Name *

Date of Birth *

Phone *

Email Address *

Agreement

Name of child*

Legal guardian consent*
I DO NOT give my child permission to sign themselves in or out
I give permission for my child to sign themselves IN on any day they are attending camps
I give permission for my child to sign themselves OUT on any day they are attending camps
I give permission for my child to sign their younger siblings IN and OUT on any day they are attending camps

Name of younger sibling(s)

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

Performance Program Self-Release Form

Signee Information

Agreement

Please enter participants' full names: