PARENTAL CONSENT

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Adult Contact (Household)








Household Address





(must be ALL CAPS with a space in between, as follows: L5M 2M5)

Child Contact

EMERGENCY CONTACT (if different than Adult Contact on Page 1)
Photo Consent (Ages 0-17)
Please review the terms and conditions regarding consent.  You may withdraw consent at any time.
I give consent for this child to have photos/videos taken to be used by PORTICO
Media Consent (Ages 11-17)
Please review the terms and conditions regarding consent.  You may withdraw consent at any time.
I give consent for this child  to receive email communication from PORTICO
I give consent for this child  to receive phone/text messages from PORTICO
Does this child have allergies/medical conditions?
Allergies and/or Medical Conditions
Please enter "Other" details here.

General Consent