KOTORICON 2017 Parental Permission Form for Minors under 18 Print out this form and bring a signed copy to registration at Kotoricon. Kotoricon is held January 6-7, 2017 on the campus of Rowan College at Gloucester County in Sewell NJ. Our website has directions, policies and contact information at http://kotoricon.org All minors under 18 are required to attend Kotoricon with an adult, preferably a parent or guardian. In instances where another adult is bringing the minor, the minor must present a signed copy of this permission form to Registration. By signing, the parent understands that we are not acting in place of a parent for the attending minor. Parent understands that they are responsible for the care, safety, and conduct of their child, whether or not they are attending with their child. Parent understands that the minor is expected to follow the convention policies, and the parent is solely responsible for policy violations on the part of the minor. Minors under 18 can attend with this signed form, when accompanied by a paid adult attendee. The minor must bring the original signed copy of this form.

Minor’s Name _______________________________________ Minor's Age on January 7, 2017________

Emergency Contact __________________________ Phone __________________________ Person other than parent or guardian responsible for this minor:

Name: _______________________________ Phone: _____________________________

“I, as the parent or guardian of the named minor, accept the rules stated above.”

Parent or Guardian’s Name:________________________________________

SIGNATURE (Parent or guardian): ____________________________ Date: ____/____/________

PHONE : ________________________ PHONE (alternate): _______________________ Print out this form and bring a signed copy to registration at Kotoricon. Kotoricon use only below this line