NOTE: Please Fill Out, Authorize and Bring to Party

(Please be advised, every child who is not a current student, must bring this form or they will not be able to participate)

Birthday Party

PERMISSION SLIP

I, ________________________________________hereby give Warrior Defense Martial Arts, Inc. permission

for my child,________________________________________ to attend a birthday party for

________________________________ at Warrior Defense Martial Inc. on (day of

week)____________________ (mm/dd/yy) ____/____/____. Should injury occur, I hereby give

my permission for trained medical personnel to administer necessary medical treatment.

Signed _____________________________________________ Date ______________________

(Parent or Guardian Name)

Emergency Phone Number: ________________________Email:_________________________

Contact Name if Emergency:______________________________________________________

Address:______________________________________________________________________

Warrior Defense Martial Arts, Inc.

813 B Flightline BL

Suite 20

Deland, Fl. 32724

386-717-4311

Sensei Ginger Mark