PERMISSION | Playroomexperiment

General Information

Parent or Legal Guardian's Full Name

Parent or Legal Guardian's Phone Number

Student's Full Name

Student's School

Student's Grade Level

Please answer the following. You can indicate NOT APPLICABLE if the question is not associated with the purpose of your filing. Thank you.

My child may participate as a game leader at the school they attend.

Yes

No

Not applicable

My child may participate as a game leader for public community events at The Playroom Experiment Gaming Space.

Yes

No

Not applicable

My child may participate in after-school gaming on Tuesdays at The Playroom Experiment Gaming Space.

Yes

No

Not applicable

My child attends L.D.S.S and may participate in lunchtime gaming at The Playroom Experiment Gaming Space.

Yes

No

Not applicable

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I confirm that I have read and fully understand the policies and terms associated with this permission form.

I confirm that I fully agree with the policies and terms associated to this permission form.

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