Free Haircuts - 2015 Kids Kuts

Please complete the information on the reverse side and return to Waukegan Township Supervisor’s Office 149 S. Genesee St., Waukegan, IL 60085 Attention Tami Springs

ALL permission slips MUST BE SUBMITTED BY Monday, JUNE 8, 2015 @ 4 pm Round trip transportation will be provided by Waukegan Township, from your child’s school.

_____________________________________________ Child’s name

Age

_____________________________________________ School

Grade

_______________ Graduation date

In case of emergency, please contact:

Name/Relationship to child _______________________________________________________________ Email Address if applicable

Contact number __________________________ Alternate Phone

Special instructions, such as food allergies, physical/medical or behavioral issues, please list below:

I, ____________________________________, do hereby give permission for my child, _______________________________________ to participate in the Coalition to Reduce Recidivism’s Kids Kuts Initiative, on June 11 & 12, 2015. I also consent to the use of his photographic likeness to be used in the future promotion of this event. _______________________________________________ Parent/guardian signature

_______________ Date