Policy: Parents or Guardian must sign on the form and all the information provided are confidential and secured. Child Information First name Last name Date of Birth Gender Male Female Grade Name of School Teacher Contact Parent or Guardian First name Lastname Phone Email Address City state zip Emergency Contact Name Phone Email Address City state zip I give my children permission TO attend summer TO attend summer To travel with staff and volunteer from shalom community impact center To be including in photos, website of shalom taken during the program Parent or Guardian Signature Upload a scaned signature here Submit