Page 1 of 1

Parental / Guardian Consent

Reciprocity’s Succession Incorporated

Complete one form per minor. A parent or legal guardian must sign.

Minor’s full name

Minor’s age

Parent or legal guardian’s full name

Relationship to minor

Parent or legal guardian’s phone

Alternate emergency contact name and phone (optional)

Participation permission

I confirm that I am the parent or legal guardian of the minor named above. I give permission for the minor to participate in programming, excursions, and other activities sponsored by Reciprocity’s Succession Incorporated.

The choice below applies to transportation provided or arranged by Reciprocity’s Succession Incorporated to and from programming, excursions, and other sponsored activities, including travel between activity sites.

Transportation permission

Yes, I authorize transportation.

No, I decline transportation.

This consent applies during the minor’s participation and ends when the minor turns 18 or I withdraw it for future activities or trips by emailing connect@reciprocitys-succession.com.

By signing below, I agree to sign electronically and confirm my choices above.

Date signed

Parent or legal guardian’s signature

Signature