Minor's Permission slip

Your child has requested to take classes at The Pagan Online Campus. Since your child is a minor, we are required to obtain parental or guardian permission prior to your child being allowed in the classes. Please complete the information below and mail this form to the address below.

Location: http://www.thepagancampus.net
Mailing Address: The Pagan Online Campus, PO Box 1188, Conroe, Texas 77305

Student Information:
Name:________________________________________________
Date of Birth:__________________________________________
Campus Nickname:_____________________________________
Student Email Address:_________________________________

Parental Information:
Name of Parent or Guardian:____________________________
Relationship to Student:________________________________
Parent Email Address:__________________________________
Telephone Number: ____________________________________

Permission Notice: My son/daughter has permission to participate in classes at The Pagan Online Campus.

_________________________________________________
(Parent's Signature and Date)

NOTE: By signing this form, I declare that I am the legal parent/guardian of the minor child listed above and authorized to grant such permission.

During this teaching/class/ workshop, the following materials may be used:
Incense, Candles, Herbs, Oils. Please indicate any allergies your child may have. Please use the back if more space is necessary.

Please print and mail this form to:
The Pagan Online Campus
PO Box 1188
Conroe, Texas 77305
Or you can fax it to (801) 757-7446

Click here for the PDF version which is more printer friendly.