Elevate Bridgeport

Sweetz N Eatz

Tuesday, February 10th

2:30 pm to 4:30 pm

Student's first name

Student's last name

Student's Phone number

Student's email address

Parent/Guardian's Full Name

Parent/Guardian's Phone Number

Parent/Guardian's Email Address

Emergency Contact Full Name

Emergency Contact Phone number

What School do you currently attend?

What grade are you in?

Do you have any food allergies? Write N/A if none.

I give permission for my child to go with Elevate Bridgeport Staff to the Elevate Office for the Sweetz N Eatz Party.

I hereby grant Elevate Bridgeport permission to use the above student's likeness in a photograph, video, or other digital media in any and all it's publications and social media.