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Empowerment Project Permission Slip

Empowerment Project Permission Slip

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Published by: Kymberli Rice-Anderson on Sep 24, 2011
Copyright:Attribution Non-commercial


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The Empowerment Project 
Permission Slip for College Tours
(Student’s Name) _____________________________ is my child and is now under my control and in my custody.
 I desire (name)_____________________ to travel to
Texas A&M University @ Commerce on
Oct 15, 2011
andparticipate in any and all activities, along with other participants from
The Empowerment Project
. In consideration ofsuch child being permitted to make such trips and participate in workshops/trainings and take part in such activitiesand the instructions of such child will be received by reason thereof, I hereby relieve and release
The Empowerment Project 
, its Owner, Employees and volunteers together with all those persons assisting with any phase of such tripsand activities (excluding paid certified carriers) from any and all liability responsibilities for making such trip andactivities and hereby release all of the said parties from all liability by reason of any accident or injury suffered by thesaid child while on the said trip or participating in such activities and I agree to indemnify and hold all said partiesharmless from all claims hereafter made by or asserted on behalf of the said student. ___________________________________________________ ____________________________ 
Parent/guardian Signature Date
The Empowerment Project 
Parent/Guardian:________________________ Signature: ____________________ Date: __________________ 
Any falsification of this document may result in removal of student from activities hosted and sponsored by The Empowerment Project.
Student’s Name______________________________Address__________________________ 
 School attending:_____________________________Grade___________________________ 
Parent’s Name_______________________________Phone number____________________ 
 Academic Interest:___________________________________________________________ Hobbies and activities:________________________________________________________ Contact: Bobby Hill 903 504 1996Kymberli Anderson 214 537 0453

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