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technodogs:forms:permission_slip [2022/10/01 16:11] worthingtechnodogs:forms:permission_slip [2022/10/01 17:00] (current) – external edit 127.0.0.1
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 <html><font size=-2 color=blue>(right click on page and choose print)</font></html>\\ <html><font size=-2 color=blue>(right click on page and choose print)</font></html>\\
-{{ :technodogs:forms:bas-logo-final-100-cropped.jpg?direct&100|}}+{{ :technodogs:forms:bas-logo-final-100-cropped.jpg?direct&150|}}
 <html><font size=+1>Parent/Guardian</font></html> \\ <html><font size=+1>Parent/Guardian</font></html> \\
 <html><font size=+1>Field Trip/Activity</font></html> \\ <html><font size=+1>Field Trip/Activity</font></html> \\
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   I hereby give may consent for  __________________________________________________________________   I hereby give may consent for  __________________________________________________________________
                                                             Student Name                                                             Student Name
-to accompany their teammates on a trip to participate in \\ +to accompany their teammates on a trip to participate in 
-**Bloomfield Girls Robotics Competition** located at **Bloomfield Hills High School** in the city of **Bloomfield Hills** on the dates of **Oct 14, Oct 15** \\ +(put name, location, date of competition here)  
-and understand that they will be transported by a Private Vehicle. +and understand that they will be transported by a Private Vehicle. \\ \\ 
-=== Authorization and Release for a Passenger in a 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. I give my permission for my child to be a passenger in a vehicle driven by a Coach or School Approved Mentor.
          
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              Parent or Legal Guardian Signature                                    Date              Parent or Legal Guardian Signature                                    Date
      
-=== Emergency Information === +**Emergency Information** \\ 
-   +
   ______________________________   ______________________________   ______________________________   ______________________________   ______________________________   ______________________________
-            Home Phone                        Cell Phone                       Work Phone +           Home Phone                        Cell Phone                       Work Phone 
-    +     
   ________________________________________   _____________________________________________________   ________________________________________   _____________________________________________________
         Name of Insurance Carrier                   Family Physician Name and Phone Number         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): 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 ===+**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 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. I release the Brighton Area Schools and such person(s) from any liability for the selection in securing of a medical provider.
technodogs/forms/permission_slip.1664640674.txt.gz · Last modified: 2022/10/01 17:00 (external edit)

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