Stierwalt Grooming Clinics
Kirk & Juli Stierwalt
Rt. 2, Box 102-B
Leedey, Oklahoma 73654
Home: 580-488-3625
Kirk's Cell: 580-302-3009
Juli's Cell: 580-302-3006
Fax 580-488-3629

I will be attending the  ___________________________, 2008 clinic in _________________________________________________(City & State).

We, the parents of___________________________________________________, {if a minor) or I

__________________________________________give our/my permission to Kirk or Juli Stierwalt to enter this individual at any hospital for any emergency treatment necessary.

We/I also release Kirk or Juli Stierwalt from any and all liability which might occur from any illness, injury or accident.

____________________________________________________
Parent/Guardian or Individual Signature

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