8/13/2019 Art & Nature for Club youTHink (Packet)

1/3

ease save your space by submitting a completed trip slip. The RSVP deadline is

Wednesday, February 19. Please turn this in by:

texting a photo of the form to 323-364-3187

Saturday, February 229 am - 2 pm (8 am - 3 pm with transportation)Ernest E. Debs Regional Park

Art&Nature

Learn how to make your very own Huichol yarn paintings! Have fun outdoors in an LA park.

Meet and work with youth from all over LA.

Transportation and lunch will be provided.

for Club youTHink

8/13/2019 Art & Nature for Club youTHink (Packet)

2/3

I understand that adequate and appropriate supervision will be provided. I recognize, however, thatunanticipated situations and problems can arise during any event, which situations or problems are notreasonably within the control of the supervising youTHink and/or Zimmer Childrens Museum staff (includingvolunteers). In such instances, I agree that the Zimmer Childrens Museum and the supervising youTHinkand/or Zimmer Childrens Museum staff (including volunteers) are not to be held legally responsible in theevent of accident or injury and I will hold the Zimmer Childrens Museum and the supervising youTHink and/orZimmer Childrens Museum staff (including volunteers) harmless from any costs, liability, or related expenses.

I give permission for emergency medical attention to be administered should that be necessary while at thisretreat. I also give my permission for photos of my child taken while participating in youTHink programs to beused in promotional materials for youTHink and the Zimmer Childrens Museum, which may include an video,website, or brochures.

Emergency Contact Information: During the fieldtrip, I can be reached at:If unable to contact parent/ guardian, in case of emergency, please call: (name, relationship and phonenumber) ______________

Students name: __________________________ School: _______________________________________Address: _________________________________ City, State, Zip: ________________________________Grade: _____ Birth date: _____________ Email: _______________________________________________Students Cell Number: _______________________________ Home Number: ________________________Parent/Guardians Signature: _____________________ Print Name:________________________________

I hereby grant permission for my child to participatein the following event:Destination:Art & Nature for Club youTHinkErnest E. Debs Regional Park4235 Monterey Rd, Los Angeles, CA 90032

Date:Saturday, February 22, 2014

Departure Time: Return Time:

8:00 am 3:00 pmI understand that transportation will be by:Shuttle / Bus

Engaging Students in Contemporary Issuesand Civic ction Through rt

youTHink Staffwill call participating students afew days before the event to confirm the

pickup times, pickup location and other tripdetails. Please feel free to call Lucy Mendez at323-364-3187 for details.

Art & Nature for Club youTHink: Permission Form

A program of the Zimmer Childrens Museum6505 Wilshire Boulevard 100 Los Angeles, CA 90048

Phone: (323) 761-8311 Fax: (323) 761-8990www.youthink.org

I understandthat submitting a permission slipdoes NOT guarantee your childs participationat the event. Space is limited and youTHinkStaff reserves the right to select students based

on transportation capacity and other programconsiderations.

http://www.youthink.org/http://www.youthink.org/

8/13/2019 Art & Nature for Club youTHink (Packet)

3/3

Entendemos se proporcionar supervisin adecuada y apropiada. Reconocemos sin embargo, que puedensurgir situaciones y problemas imprevistos en cualquier viaje, problemas que no estn bajo el control delsupervisor de youTHink o del Museo Infantil Zimmer (incluyendo sus voluntarios). En tales casos, nosotrosconvenimos en que ni el Museo Infantil Zimmer ni el supervisor o los voluntarios de youTHink y/o del MuseoInfantil Zimmer debern ser hechos legalmente responsables. En caso de accidente o herida, mantendremos atodo el personal de youTHink y/o el al Museo Infantil Zimmer (incluyendo a los voluntarios) libre de cualquiercosto, obligacin, o gastos relacionados a este.

Yo/Nosotros otorgamos permiso para que se administre cualquier atencin mdica en caso de una emergenciadurante este paseo. Yo/Nosotros tambin otorgamos permiso de utilizar fotografas tomadas durante estepaseo para publicaciones y materiales promocinales de youTHink y del Museo Infantil Zimmer, al igual quevideos institucionales, pgina de Internet, folletos y ocasionalmente peridicos.

Durante el paseo, podr ser contactada/o al: En un caso de emergencia en el queno sea posible contactar a padres/guardianes, favor de llamar a al nmero(como esta relacionada esta persona? To? Ta? Abuela? Etc.)

Nombre del estudiante: __________________________ Escuela: _______________________________________Domicilio: _________________________________ Ciudad, Estado, Cdigo Postal: _________________________Grado: _____ Fecha de nacimiento: _____________ Correo electronico: ________________________________Nmero de celular del estudiante: _____________________ Nmero telefnico de casa: ___________________Nombre en imprenta de padre/guardin: _________________Firma de padre/guardin: _________________

Yo/Nosotros otorgamos permiso para que mihija/hijo participe en el evento:Destino:Arte y Naturaleza por Club youTHinkErnest E. Debs Parque4235 Monterey Rd, Los Angeles, CA 90032

Fecha:

Sbado, 22 de Febrero del 2014

Hora de Salida: Hora de Regreso:8:00 am 3:00 pmEntendemos que el transporte ser a travs de:

Autobs/Camin

Engaging Students in Contemporary Issuesand Civic ction Through rt

Personal de youTHinkllamar a los estudiantesparticipantes unos das antes del evento para

confirmar las horas de recoleccin, el lugar derecoleccin, y otros detalles del viaje. Por favor,llamen a Lucy Mendez a 323-364-3187 paradetalles.

Arte & Naturaleza por Club youTHink: Forma de Permiso

A program of the Zimmer Childrens Museum6505 Wilshire Boulevard 100 Los Angeles, CA 90048

Phone: (323) 761-8311 Fax: (323) 761-8990www.youthink.org

Por favortenga en cuenta que presenter unaforma de permiso NOgarantiza la participacionde su hijo/a en el evento. Hay espacio limitado

y el personal de youTHink reserve el derechode seleccionar a los estudiantes en base de lacapacidad del transporte y los objetivos del

ro rama.

http://www.youthink.org/http://www.youthink.org/