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--- technodogs:forms:permission_slip [2022/10/01 15:44] – worthing
+++ technodogs:forms:permission_slip [2022/10/01 17:00] (current) – external edit 127.0.0.1
@@ Line 1: / Line 1: @@
-{{ :technodogs:forms:bas-logo-final-100-cropped.jpg?direct&200|}}
+<html><font size=-2 color=blue>(right click on page and choose print)</font></html>\\
-<html><font size=+2>Parent/Guardian</font></html> \\
+{{ :technodogs:forms:bas-logo-final-100-cropped.jpg?direct&150|}}
-<html><font size=+2>Field Trip/Activity</font></html> \\
+<html><font size=+1>Parent/Guardian</font></html> \\
-<html><font size=+2>Permission Form</font></html> \\
+<html><font size=+1>Field Trip/Activity</font></html> \\
+<html><font size=+1>Permission Form</font></html> \\
-----
-<html><font size=+1>Name of School: <strong>Brighton High School</strong></font></html> \\
-<html><font size=+1>Name of Organization: <strong>Robotics Team - FRC 3707 - The TechnoDogs</strong></font></html> \\
-\\
-I hereby give may consent for
+<html><font>Name of School/Org: <strong>Brighton High School Robotics Team </strong></font></html> \\
+  I hereby give may consent for  __________________________________________________________________
+                                                            Student Name
+to accompany their teammates on a trip to participate in
+(put name, location, date of competition here)
+and understand that they will be transported by a Private Vehicle. \\ \\
+**Authorization and Release for a Passenger in a Vehicle ** \\
+I give my permission for my child to be a passenger in a vehicle driven by a Coach or School Approved Mentor.
-  _____________________________________________________________
+  _____________________________________________________________             __________________
-                        Student Name
+             Parent or Legal Guardian Signature                                    Date
-to accompany their teammates on a trip to participate in \\ \\
+**Emergency Information** \\
-**Bloomfield Girls Robotics Competition** located at **Bloomfield Hills High School** in the city of **Bloomfield Hills**	on the dates of **Oct 14, Oct 15** \\ \\
-and understand that they will be transported by a Private Vehicle.
-=== Authorization and Release for a Passenger in a Vehicle ===
+  ______________________________   ______________________________   ______________________________
-I give my permission for my child to be a passenger in a vehicle driven by a Coach or School Approved Mentor.
+           Home Phone                        Cell Phone                       Work Phone
+  ________________________________________   _____________________________________________________
+        Name of Insurance Carrier                   Family Physician Name and Phone Number
+Medication that **must accompany the child** and information that you wish to share (ie. allerigies, medications, medical conditions, etc):
+   ______________________________________________________________________________________________________
+**Authorization and Release for Medical Care ** \\
+I authorize Brighton Area Schools, its employees, designees, or sponsors in attendance at any Brighton Area Schools or Robotics Team event to secure, select and consent to necessary medical attention for may child resulting from injury, illness or accident requiring medical care while I am not in attendance. \\
+I release the Brighton Area Schools and such person(s) from any liability for the selection in securing of a medical provider.
-  _____________________________________________________________             _________________
+  _____________________________________________________________             __________________
-               Parent/Guardian Signature                                           Date
+             Parent or Legal Guardian Signature                                    Date
-=== Emergency Information ===
-  ________________________________________         ________________________________________
-               Home Phone                                         Cell Phone
-  ________________________________________         ________________________________________
-               Work Phone                                         Other Phone
-  ________________________________________         ________________________________________
-        Name of Insurance Carrier                              Family Physician
-                                                   ________________________________________
-                                                            Physician's Phone Number