Natural Resources Field Trip Permission Slip

Dates

8/21/23

8/23/23

9/23/23

9/24/23

Time

Destination

Daytime - Outdoor Camp

Check all that apply

Participant/Youth Name(Required)

First Last

Participation/Youth Phone

Allergies or Special Needs

Parent/Guardian Name(Required)

First Last

Parent/Guardian Cell Number(Required)

Parent/Guardian Home Number

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 my child up at

I will pick up my child at the Natural Resources Building after the event

Location for youth to be picked up

Permission to Seek Medical Attention, Release of Liability, Waiver of Claims, Assumption of Risk 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 forever release, indemnify, 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 anyway 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