Recreation Field Trip Permission Form | Lower Elwha Klallam Tribe

Recreation Phone Number(Required)

I have saved the recreations cell number 360-912-4989

Booster Seat Requirement

I will send a booster seat with my child.

Your child must be at least 4ft 9 in tall to not be in a booster seat. Parents must provide Booster Seats for the field trip, if one is not provided, your child cannot go on the trip.

Trip Information

Field Trips will be taking 24 Kids. Please provide your child with their Boost Seat. They cannot go if they do not have one.

Parent/Guardian Name(Required)

First Last

Parent/Guardian Number(Required)

Home Phone

How Many Youth are you signing up?

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Transportation(Required)

I will pick up my child at the Tribal Center after the event.

I will pick up my child after the event at

Location for youth to be picked up

Participant/Youth 1 - If your child uses a booster seat, please send it with them.

Participant/Youth Name(Required)

First Last

Age(Required)

Grade (23-24 School Year)(Required)

Allergies or Special Needs

Other physical or psychological condition that the Recreation Staff should know about?

Yes

If Yes, what should we know?

Participant/Youth 2 - If your child uses a booster seat, please send it with them.

Participant/Youth Name(Required)

First Last

Age(Required)

Grade (23-24 School Year)(Required)

Allergies or Special Needs

Other physical or psychological condition that the Recreation Staff should know about?

Yes

If Yes, what should we know?

Participant/Youth 3 - If your child uses a booster seat, please send it with them.

Participant/Youth Name(Required)

First Last

Age(Required)

Grade (23-24 School Year)(Required)

Allergies or Special Needs

Other physical or psychological condition that the Recreation Staff should know about?

Yes

If Yes, what should we know?

Participant/Youth 4 - If your child uses a booster seat, please send it with them.

Participant/Youth Name(Required)

First Last

Age(Required)

Grade (23-24 School Year)(Required)

Allergies or Special Needs

Other physical or psychological condition that the Recreation Staff should know about?

Yes

If Yes, what should we know?

Participant/Youth 5 - If your child uses a booster seat, please send it with them.

Participant/Youth Name(Required)

First Last

Age(Required)

Grade (23-24 School Year)(Required)

Allergies or Special Needs

Other physical or psychological condition that the Recreation Staff should know about?

Yes

If Yes, what should we know?

Release of Liability, Permission to Seek Medical Attention, and Media Release Agreement

By signing below I acknowledge and accept the risk of participation in the above-referenced trip. I agree, as the parent/legal guardian, to release, discharge and hold harmless the Lower Elwha Klallam Tribe and its officers and employees from any and all liability, claims, damages, costs, expenses, loss, and causes of action that in any way and at any time arise out of my child’s participation in the above-referenced trip.

I agree to discuss with my minor child the importance of abiding by all rules, guidelines and instructions set forth by the Tribal staff regarding this activity. I give permission for a Lower Elwha Klallam Tribal Staff Member to seek medical care for the above listed minor child and to sign the appropriate consent forms that are necessary to carry out the treatment of my minor child in my absence.

I give my consent for the Lower Elwha Klallam Tribal Staff to take and use photos and/or videos of my child for language publications that may be shared via multimedia such as the Tribal and/or local newspaper, DVD’s or Tribal internet websites such as YouTube.

Signature(Required)

Signed Date