Youth Permission Slip

Submit the following details and once complete, you will review and sign the waiver.

Minor's Name *

First

Last

Minor's Date of Birth

01/01/1952

Parent's / Guardian's Name *

First

Last

Is the Parent / Guardian an Illinois Resident *

Parent's / Guardian's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent's / Guardian's Date of Birth

Email *

Drivers License # *

Parent's / Guardian's Phone *

Website

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