Summer Field Trip Consent Form – M.I. Mother’s Keeper

Summer Trip Consent Form

(please make sure to fill out the entire form, once for each child)

I *

Declare that I am the legal Parent/Guardian of: *

Gender of child *

Born on: *

My child, *

Has my consent to travel to:

KICK OFF GOLF CLINIC
\\nCITY OF SEAT PLEASANT
\\nGOODWIN PARK
\\n641 G STREET
\\nSEAT PLEASANT, MD.
\\nSATURDAY, JULY 24TH, 2021
\\n10 AM – 1 PM
\\n(FREE ADMISSION)

Will the child attend the activity above? *

BUSCH GARDENS WILLIAMSBURG AMUSEMENT PARK
\\n1 BUSCH GARDENS BLVD.
\\nWILLIAMSBURG, VA. 23185
\\nSATURDAY, AUGUST 14TH, 2021
\\n7 AM – 12 AM
\\n($60.00 EACH CHILD)
\\n($70.00 EACH ADULT)

Will the child attend the activity above? *

Please indicate any allergies that your child may have:

Authorized Parent/Guardian agrees to release, indemnify and hold harmless, M.I. Mother’s Keeper, its directors, officers, employees, volunteers, etc. of its activities from any and all claims, causes of actions and liability arising from or in any way connected with their child’s volunteer participation with M.I. Mother Keeper’s Summer Field Trip Events with Rhonda Hamilton from M.I. Mother’s Keeper of 1629 K Street, N.W., Suite 300 Washington, D.C. 20006. www.mimotherskeeper.com e-mail: advocates4mi@gmail.com P.O.C.: Mrs. Hamilton at 240-274-9436.

Signed on this: *

Day of: *

Phone number: *

Name & signature *

*Any participants found to be unruly & disruptive will not be included on any future trips. \\n\\n
*PLEASE NOTE THAT DATES ARE SUBJECT TO CHANGE; YOU WILL BE NOTIFIED IF CHANGED.

I authorize and consent to my child's participation upon the submission of this form. *

I consent.

Summer Trip Consent Form

(please make sure to fill out the entire form, once for each child)

M.I. is ME!

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