Guardian Consent Form

By filling out and submitting this Guardian Consent form, you agree to the collection, use, and disclosure of your child(ren)s personal information as stated in the Community Grown Heroes COPPA Statement and Privacy Policy. By filling out and submitting this form, you also agree that you have read and understood both the Community Grown Heroes COPPA Statement and Privacy Policy.

- Step 1 of 4

Legal Guardian Name *

First

Last

What is your relationship to the child(ren) whos information your are providing on this form? *

Legal Guardian Email *

Legal Guardian Phone Number *

Next

How many children do you need to give consent for on this form? *

• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10

Child Name #1 *

First

Last

Providing a name is for benefiting the child's relationship with us and others in this program. Feel free to use a nickname instead of their legal given name.

What Grade is this child in?123456789101112

Child Name #2

First

Last

What Grade is this child in?123456789101112

Child Name #3

First

Last

What Grade is this child in?123456789101112

Child Name #4

First

Last

What Grade is this child in? 123456789101112

Child Name #5

First

Last

What Grade is this child in? 123456789101112

Child Name #6

First

Last

What Grade is this child in?123456789101112

Child Name #7

First

Last

What Grade is this child in?123456789101112

Child Name #8

First

Last

What Grade is this child in?123456789101112

Child Name #9

First

Last

What Grade is this child in? 123456789101112

Child Name #10

First

Last

What Grade is this child in?123456789101112

Next

Are there any instructions or notes we should know about each child listed on this form?

Next

My virtual signature evidences that I accept general liability for the participation of my child(ren) in the activities, clubs, or sports, both online and in person identified in the description of the membership I have purchased to enroll my child(ren) in and that I agree to indemnify and hold harmless BSW Academy, Inc., the school(s), its teachers, its sponsors, its governing board, and other participating agents, either jointly or severally, from and against any and all claims, injuries, damages, losses, costs, or causes of action that may arise in connection with these activities, clubs, or sports. *

• Yes, I provide my consent

Guardian Signature *

Clear Signature

Submit