Permission Slip/Application

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.