Acknowledgement *

I hereby give my full permission for my child(ren) named below to participate in the field trip named below. Check the activities you give permission for your child(ren) to participate and before event. Please note that it is not necessary to send money with your child because snacks and meals are provided. If your child feels the need to bring money, please do not send more than $5. The Ed Center and Rec staff are not responsible for their money.

Yes

Name of First Child *

First Name

Last Name

Name of Second Child

First Name

Last Name

Name of Third Child

First Name

Last Name

Date of Field Trip

MM

DD

YYYY

Release of Liability *

Transportation will be available to those who return this slip. These are drug, tobacco, alcohol-free events/trips. Please wear comfortable walking shoes and appropriate clothing. 1. I understand that as a parent/guardian. I will have the responsibility of advising my child of the risks involved, which are known or should be known of such activities. 2. I agree that my child is under the authority of the WIEC/WCC, advisors and chaperones in charge and if my child does not follow instructions of said staff and/or adults, my child shall not have the privilege of participating in future community field trips. 3. I agree that my child will be transported to and from activities, events, and trips in the Community WIEC/WCC vehicle. My child must ride back in the Community WIEC/WCC vehicle unless I, parent/legal guardian, sign for my child to be released to my care at or after the event. My child will not be released to anyone else. 4. I give my full consent to allow the WIEC/WCC Staff in charge to transport my child across the Nevada and California border and /or outside of the Woodfords vicinity. 5. I express relieve, indemnify and hold harmless the WIEC/WCC advisors and chaperones from and against any and all liability or claims arising from injury or damage suffered or incurred by my child or our property, as may be the result of acts, conduct, behavior omissions of my child and /or other person, while participating in this activity.

Yes

Name of Emergency Contact *

6. I hereby authorizes WIEC/WCC, advisors and staff to give permission for my child’s emergency medical treatment in case of injury accident or illness In case of emergency, I give my full consent for the WIEC and/or Recreation staff to contact in my absence:

First Name

Last Name

Phone number of Emergency Contact *

(###)

###

####

Name of Parent/Guardian *

By signing below I hereby agree to all the terms stated above.

First Name

Last Name

Phone Number of Parent/Guardian *

(###)

###

####