YCS Movie Rating Permission Form
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
*
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