Young Writers Studio - After School Writing Program
The Alden B. Dow Home and Studio
2017-2018 Permission Slip
FULL as of 9/22/2017-Please contact Matthew Woods at 989-839-2744 to have your student placed on a wait list to join the program
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Name:
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Comment:
Student's First Name
Student's Last Name
Email Address
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School
Name of Students English teacher
Grade
Emergency Contact Name
Emergency Contact (phone)
List any special medical information or concerns
Parents/Guardians digital signature of consent
Student will attend
October 10th
Student will attend
November 14th
Student will attend
December 12th
Student will attend
January 9th
Student will attend
February 13th
Student will attend
March 13th
Student will attend
April 10th
Student will attend
May 8th
Parental/Guardian Consent
Student will ride bus and parent will pick up
Parental/Guardian Consent
Parent will drop off and pick up student
Parental/Guardian Consent
Photo of student may be used in marketing materials, on social media and website
Parental/Guardian Consent
Student will be able to contribute snacks or water for the final count of members
Parental/Guardian Consent
Student may receive emergency medical treatment if necessary
Parental/Guardian Consent
Student may attend field trips
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