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Family Outreach

DVD from Mom/Dad Permission Form


Are you the legal guardian of child(ren)?

Certification and Release Statement

I authorize investigation of all statements contained in this document as may be necessary in my child(ren) receiving a DVD from Mom/Dad. I also certify that I am the legal guardian of

who will be receiving the DVD from Mom/Dad through Christian Heritage. I certify that the information given herein is true and complete and that submission of this form is the same as my signing this form.

Questions? Please call or text Andi at 402-805-1143 or email her at andib@chne.org.

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