7/30/2019 Discover College Flyer-Seniors 5-29-13 Packet

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7/30/2019 Discover College Flyer-Seniors 5-29-13 Packet

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A program of the Zimmer Childrens Museum6505 Wilshire Boulevard #100 Los Angeles, CA 90048

Phone: (323) 761-8311 Fax: (323) 761-8990www.youthink.org

RETURN THIS NO LATER THANFriday, May 24, 2013

Engaging S tudents in Contemporary Issues and Civic Action Through ArtyouTHink Field Trip Permission Form

I hereby grant permission for my child to participate in the Discovering College Workshop

Destination:Zimmer Childrens Museum6505 Wilshire Blvd.LA, CA 90048

Date: Wednesday, March 29, 2013Departure Time: 4:00pm Return Time: 8:30 pm

I understand that transportation will be by: Bus /Shuttle .I understand that adequate and appropriate supervision will be provided. I recognize, however, thatunanticipated situations and problems can arise on any trip, which situations or problems are notreasonably within the control of the supervising youTHink and/or Zimmer Childrens Museum staff(including volunteers). In such instances, I agree that the Zimmer Childrens Museum and the supervising

youTHink and/or Zimmer Childrens Museum staff (including volunteers) are not to be held legallyresponsible in the 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 anycosts, liability, or related expenses.

I give permission for emergency medical attention to be administered should that be necessary while onthis fieldtrip. I also give my permission for photos of my child taken while participating in youTHinkprograms to be used in promotional materials for youTHink and the Zimmer Childrens Museum, whichmay include an 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 phonenumber)

Students name: __________________________ School: ______________________________Address: _________________________________ City _____________________ State_____ Zip _________Grade: _________ Track: ______ Birth date: _____________________ Date: ___Parent/Guardian(s) Signature: Home : ______Print Parent/Guardian(s) Name: _______________ Cell Number: ____________________

RETURN TO TEACHER:

Please note: Submitting a permissionslip does NOT guarantee your childs

participation at the event. Space is limitedand youTHink Staff reserves the right

to select students based ontransportation capacity and other

program considerations.

7/30/2019 Discover College Flyer-Seniors 5-29-13 Packet

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6505 Wilshire Boulevard #100 Los ngeles, CA 90048Telfono: (323) 761-8311 Fax: (323) 761-8990www.youthink.org

ENTREGE ESTA FORMA ANTES DELviernes, 24 de mayo del 2013Iniciando a los estudiantes en temas modernos y accin cvica a travs de Arte

Permiso para el paseo con youTHinkYo/Nosotros otorgamos permiso para que mi hija/hijo participe en un taller de la universidad:

Destino:Zimmer Childrens Museum6505 Wilshire Blvd.LA, CA 90048

Fecha: Miercoles 29 de mayo del 2013Hora de Salida:4pm Hora de Retorno:8:30pmEntendemos que el transporte ser a travs de: CaminEntendemos se proporcionar supervisin adecuada y apropiada. Reconocemos sin embargo, quepueden surgir situaciones y problemas imprevistos en cualquier viaje, problemas que no estn bajo elcontrol del supervisor de youTHink o del Museo Infantil Zimmer (incluyendo sus voluntarios). En talescasos, nosotros convenimos en que ni el Museo Infantil Zimmer ni el supervisor o los voluntarios de

youTHink y/o del Museo Infantil Zimmer debern ser hechos legalmente responsables. En caso deaccidente o herida, mantendremos a todo el personal de youTHink y/o el al Museo Infantil Zimmer(incluyendo a los voluntarios) libre de cualquier costo, obligacin, o gastos relacionados a este.

Yo/Nosotros otorgamos permiso para que se administre cualquier atencin mdica en caso de una

emergencia durante este paseo. Yo/Nosotros tambin otorgamos permiso de utilizar fotografas tomadasdurante este paseo para publicaciones y materiales promocinales de youTHink y del Museo InfantilZimmer, al igual que videos institucionales, pgina de Internet folletos y ocasionalmente peridicos.

Durante el paseo, podr ser contactada/o al: En un caso de emergencia enel que no sea posible contactar a padres/guardianes, favor de llamar a al nmero

(como esta relacionada esta persona? To? Abuela? Etc.)

Nombre del estudiante: Escuela: ____________Domicilio __ Ciudad, Estado, Cdigo Postal: ________Grado: ______ E-mail: ______ _______________ Fecha de nacimiento: ________________________Nmero telefnico: Numero celular: ______Nombre en imprenta de padre(s)/guardin(es):Firma de padre(s)/guardin(es): Fecha:

Por favor tenga en cuenta que presentar una

forma de permiso NO garantiza la participacion de

su hijo/a en el evento. El personal youTHink,

reserva el derecho de seleccionar a los estudiantes

en base de la capacidad del transporte y los

objetivos del evento.

http://www.youthink.org/http://www.youthink.org/http://www.youthink.org/