Of SPokane County

Dear Parent(s) or Guardian(s): The BE GREAT Club will be taking their members to Liberty Pool for swimming lessons. All interested members must have a signed permission slip returned to their Clubhouse front desk staff by Tuesday, August 7th in order for your child to participate. If you have, any questions or concerns feel free to contact Shamerica Daniels, Clubhouse Director at (509) 5368152.

EVENT LOCATION

SWIMMING LEVELS
Barracudas

DAYS
Monday Thursday Monday Thursday Monday Thursday

DATES

DEPARTING AT

RETURNIN G AT

Liberty Pool 1300 E. 5th

Dolphins Seals

August 616th

9:30 am

4 pm

Please have your child at their Clubhouse before the scheduled departure time.
Cut here, bring bottom half to your Clubhouse Front Desk Staff MEMBER NAME: __________________________________________________ GRADE: _______________________ GUARDIAN NAME: _______________________ My child has the following special medical/health needs: ____________________________________________________________________________________________________ ________________________________________________________________________________________________ PARENT OR GUARDIAN APPROVAL
I/we the parents or guardians of the above named members of the Boys & Girls Club of Spokane County give approval for participation in the above Club-sponsored activity. I/we assume all risks and hazards incidental to such participation including transportation to and from the activity; and hereby waive, release, absolve, indemnify and agree to hold harmless the Boys & Girls Club of Spokane County, the organizers, sponsors supervisor, participants, and persons transporting my/our child, whether the result of negligence or for any other cause. I/we further give consent to him/her being given a physical exam or emergency treatment by a

________________________________ ______ PHONE: _______________________ PHONE:

EMERGENCY CONTACT: _____________________________________ _______

physician or hospital in case of an emergency. I/we further authorize the above named for pictures which may be used in Club publicity.

My child, _______________________________________________has permission to be transported by a chartered school bus to Liberty Pool to participate in swimming lessons taught by the Spokane Parks Department from August 6 - 16, 2012.

PARENT/GUARDIAN SIGNATURE

DATE