Northeast Wisconsin Jr. Gamblers AAA Hockey

I (We), and

am (are) the parent(s) or legal guardian(s) of ,

a minor age , born address

city state USA.

 

I (We) authorize my (our) , an adult, who

resides at ,

to transport from the UNITED STATES the above named minor, to participate in a

hockey tournament to be held in the city of , .

This consent is for the period from to

 

.

______________________________________________
PARENT OR GUARDIAN SIGNATURE

 

SUBSCRIBED AND SWORN TO

before me the ____day of _______________, __________

______________________________________________
Notary Public