Minor Participation Program Release Request

Name of School/Group Minor is attending the Education Program through: *

Location of School or Group *

Name of Group Organizer: *

Completion of this form is necessary to request the release a minor participant from the above Students on Tour Education Program. Please complete and sign this form. The form will be emailed to both parties below:

► Students on Tour
► Organizer

Name of Minor/Student Participant

Name of Student/Minor leaving this program: *

Release Date from program: * +

Time Leaving *

AM / PM *

AM

PM

Where will the participant be leaving the program from? (ex: hotel, airport, address, etc.) *

Release City *

City State *

Name of Parent/Guardian that Minor is being released to:

(The Guardian/Parent will be required to provide photo identification to a representative from the school/group and the Education Program Leader - EPL)

First Name *

Last Name *

The Address of the Parent/Guardian to whom the minor child is being released:

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address