| Date:
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10/18/2024 0411 |
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| Parent/Guardian Info: |
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| First and Last Name: :
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| Address: :
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| City: :
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| State:
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| Email: :
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| Telephone Number You Can Be Reached At: :
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| Child Information: |
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| Name: :
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| Age: :
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| Gender: :
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| T-Shirt Size :
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Any Special Need to Know Information: :
Please describe any special need, dietary, allergies, or other information you feel we should be aware of:
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| Emergency Contact: |
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| Emergency Contact Name: :
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| Emergency Contact Phone Number: :
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| Person Authorized To Pick Up Your Child(ren) :
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| *Parental Permission for Use of Image/Photos* |
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Photo/Image Permission :
Occasional, Photos of Abingdon Fire Company participants are on our social media outlets. Participants and presenters from local, state, and federal agencies may also include participants on their social media outlets. We DO NOT include the name(s) of your child or “tag” them in the picture.
For your child’s image to be included, Abingdon Fire Company must have your written permission on file while they participate in the Abingdon Fire Company Safety Matters program. Furthermore, I understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
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