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PERMISSION SLIP

Gallatin County Public Library 200 West Market St.


Warsaw, Ky. 41095 859-567-2786
I ____________________________ give permission for
my
child, ________________________________________ to
attend

LEGO Mania

All ages are


welcome

Dec. 30th 10:00 a.m. -3:00 p.m.

Light refreshments will be served


Childs Name: ___________________________________________

Please Check

Date of Birth: ___________________________________________

M__

F__

Allergies: ______________________________________________
Medical Conditions:
___________________________________________________________________
Parent or Legal Guardian Phone Number:
__________________________________________________
Alternate Emergency Contact Name and Number:
___________________________________________
My child will be:
Has my permission to walk home to this address:
___________________________________________
Picked up by:
________________________________________________________________________
**If your child is to be picked up, that person HAS to come in and sign the
child out**

Parent/Guardian Signature
_________________________Date________
Children will NOT be permitted to leave the building prior to the event
ending.

*PLEASE NOTE* someone from the Library will contact you prior to this event to
ensure the phone number provided is in good working condition. If we are not able
to make contact with someone on the number provided prior to this event, the child
will NOT be permitted to attend.