7/30/2019 College Camp 12th Permission Slip June 11-13 2013

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A program of the Zimmer Childrens Museum6505 Wilshire Boulevard #100 Los Angeles, CA 90048Phone: (323) 761-8911 Fax: (323) 761-8990www.youthink.org

Engaging Students in Contemporary Issues and Civic Action Through ArtyouTHink COLLEGE CAMP for rising 12th graders

The application for College camp involves two steps, both due Thursday, June 6th:1. Please complete the application at http://http://yTcollegecamp12.eventbrite.com2. Please complete and sign this participation contract with a parent or guardian and return to:

Mail: youTHink Fax: (323) 761-8990 Email:Tasha@youthink.org6505 Wilshire Blvd. #100Los Angeles, CA 90048

ATTN: Tasha Johnson

Participation Contract:I am applying to participate in the youTHink College Camp- June 11-13, 2013.At Marymount College30800 Palos Verdes Drive EastRancho Palos Verdes, CA 90275

My parent/ guardian and I understand and agree to the following:

We understand that the camp is 3 sessions long and that I must attend all the sessions toparticipate.

We understand that transportation will be provided, if requested. We also understand that if weare running late or will not be at the shuttle stop, we need to contact Tasha Johnson at (703)725-8349 as soon as possible.

Although we are not being charged to participate in this camp, we understand that youTHinkCollege Camp isvalued at $400/ student. We also understand that there are limited openings in this camp, so we agree to call Tasha at

(703) 725-8349 IMMEDIATELY, if I (student) become unable to attend, so another student can beoffered the opportunity.

I (parent/guardian) give permission for photos/video of my child taken while participating inyouTHink programs to be used in promotional materials for youTHink and the Zimmer ChildrensMuseum, which may include an institutional video, website, or brochures.

I understand that transportation will be by: Shuttle / Car . I understand that adequate and appropriate supervision will be provided. I recognize,

however, that unanticipated situations and problems can arise on any trip, which

http://ytcollegecamp12.eventbrite.com/http://ytcollegecamp12.eventbrite.com/http://ytcollegecamp12.eventbrite.com/mailto:Tasha@youthink.orgmailto:Tasha@youthink.orgmailto:Tasha@youthink.orgmailto:Tasha@youthink.orghttp://ytcollegecamp12.eventbrite.com/

7/30/2019 College Camp 12th Permission Slip June 11-13 2013

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A program of the Zimmer Childrens Museum6505 Wilshire Boulevard #100 Los Angeles, CA 90048Phone: (323) 761-8911 Fax: (323) 761-8990www.youthink.org

situations or problems are not reasonably within the control of the supervising youTHinkand/or Zimmer Childrens Museum staff (including volunteers). In such instances, I agreethat the Zimmer Childrens Museum and the supervising youTHink and/or ZimmerChildrens Museum staff (including volunteers) are not to be held legally responsible inthe event of accident or injury and I will hold the Zimmer Childrens Museum and thesupervising youTHink and/or Zimmer Childrens Museum staff (including volunteers)

harmless from any costs, liability, or related expenses.

I give permission for emergency medical attention to be administered should thatbe necessary while on this fieldtrip. I also give my permission for photos of mychild taken while participating in youTHink programs to be used in promotionalmaterials for youTHink and the Zimmer Childrens Museum, which may includean institutional video, website, or brochures.

Emergency Contact Information: During the fieldtrip, I can be reached at:

If unable to contact parent/ guardian, in case of emergency, please call: (name,relationship and phone number)

__________________________ _______________________________PRINT Student Name PRINT Parent/Guardian Name

__________________________ _______________________________Student Signature and Date Parent/Guardian Signature and Date