Into the Wild CONSENT FORM Name * First Name Last Name Date of Birth * MM DD YYYY Medication details * Does the participant suffer from any condition that requires medical treatment, including medication? If yes please give details below. Please bring any prescribed medication with you on the day. Dietary requirements * When are you attending? MM DD YYYY Time of party If applicable Hour Minute Second AM PM Parent / Guardian Name * First Name Last Name Email * Phone * (###) ### #### Thank you!
