[City of Irvine] MSYAT Participant Permission/Emergency Form 58-36

Signature HereClick to Sign

10/29/2025Click to Sign

Your Name HereClick to Sign

The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, all information provided on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.

Additional Signatures Required

	Signer Details	Me?
Parent/Guardian Signature
I'm not a signer listed above

Print Document

Create Your Signature

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers