Print and mail completed form to:
New Jersey WAVE
c/o Voorhees Pediatric Facility
Attention: Tricia Cunningham
1304 Laurel Oak Road
Voorhees, NJ 08034-4392
I, ____________________________ (Parent/ Guardian),
have received and reviewed the Information packet regarding
the NJ Wave Program, sponsored by the American Lung
Association. I do, hereby, give my permission/release
for ___________________ (Child) to attend this residential
program from Monday June 24 through Thursday June 26, 2014, and to
participate in all associated activities.