Waukegan Township & Shawall Temple present
Annual Children’s Holiday Shopping Spree Complete and return _____________________________________________ Child’s name
Age
_____________________________________________ School
Grade
Date of birth
Open to Waukegan Township Residents only. In case of emergency, please contact:
Name/Relationship to child
Cellular Phone
___________________________________________________________________________________ Complete Mailing Address (Please Verify) _____________________________________________________________________ Email Address if applicable
______________________________ Alternate Phone
Special instructions, such as food allergies, physical/medical or behavioral issues:
Must apply at Township Supervisor’s Office, 149 S. Genesee St. or Park Place, 414 S. Lewis Ave. See reverse side for additional information. I give permission for my child/children, _________________________________ to attend the field trip to the Annual Children’s Holiday Shopping Spree. X___________________________________________________________
I give permission for my child,__________________________________________ to attend the field trip to the Annual Children’s Holiday Shopping Spree and have his/her photographic likeness used in future promotion of this event. Parent/guardian signature X___________________________________________________________
Revised October 16, 2015