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The undersigned parent/guardian gives permission to_______________________________________________
to attend _________________ (project) on ________(date). Participants should bring sleepingbag, work clothes, toiletries, spending money, etc. Food, transportation, and lodging will be supplied. By my signature below, I hereby release and hold harmless the American Friends Service Committee, Southern California Quarterly Meeting, Orange Grove Meeting, Whittier First Friends Church and all persons acting pursuant to its authority, from any and all liability for foreseen and unforeseen damages to the person and property of the minor listed above. I have been given a signed copy of this form for my records.
The undersigned parent/guardian and youth understand that the following behavioral guidelines apply for all participants: no alcohol, cigarettes or illegal drugs, no inappropriate sexual behavior, and no leaving of the group without the permission of adult helpers. Participants are encouraged to show respect towards one another and towards adult helpers. Put-downs, gossip, and cliques are to be avoided.
In case of medical emergency, parent/guardian gives consent for MEDICAL TREATMENT to be given to participant by CERTIFIED MEDICAL PROFESSIONALS or by qualified AFSC staff. I also give permission for my child to be transported by ambulance or car to an emergency center for treatment. I understand that accident or health insurance is the responsibility of parents or legal guardians.
__________________________________ _______________________________________
Printed name of Parent/Guardian Signature of Participant
_________________________________ _______________________________________
Signature of Parent/Guardian Address (Street)
______________________________________________________________________________
City State Zip
________________________________ ________________________________________
Date Signed Phone number of Parent/Guardian
Emergency Phone Number (e.g. at work)
________________________ __________________________________________
Name of Participant's Physician Physician's Phone Number
_____________________ _____________________
Medical Insurance Company Insurance Number
_________________________________
Name of employer (if provider of insurance)
Those over 18 do not need parental permission but must fill out the rest of the form.
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