YCS Movie Rating Permission Form

Child #1 Name Child #1 Name * First Last
What program(s) is child #1 enrolled in? *

What program(s) is child #1 enrolled in? Summer Rec. Day Camp Summer Teen Camp Feb./April Vacation Camp Other Other
Child #1 has permission to watch movies that are rated: *

Child #1 has permission to watch movies that are rated: G PG PG-13 R

Check all that apply
Child #2 Name Child #2 Name First Last
What program(s) is child #2 enrolled in?

What program(s) is child #2 enrolled in? Summer Rec. Day Camp Summer Teen Camp Feb./April Vacation Camp Other Other
Child #2 has permission to watch movies that are rated:

Child #2 has permission to watch movies that are rated: G PG PG-13 R

Check all that apply
Parent Digital Signature *

Clear
Parent Email *
Parent Cell/Home Phone Parent Cell/Home Phone * - ### - ### ####