Youth Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

All children and youth, between the ages of 3-17 years old, are eligible for a haircut.

MM

DD

YYYY

Parent/Guardian Name *

First Name

Last Name

Phone Number *

(###)

###

####

Signature *

I am the parent / legal guardian of the participant who is under 18 years of age to whom the above statement applies.

I acknowledge that I have read and agree to the above Terms and Conditions.

I acknowledge that I have read and agree to the below Accident Waiver and Release of Liability.

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me from Cuts For Kids Foundation events.

I want to be notified of future Cuts For Kids Foundation events and news.