PO Box 114 Georgetown Massachusetts 01833

Phone: +1 732-249-4227 www.modelun.com www.idia.net

STUDENT PERMISSION SLIP

I hereby give permission for my child _______________________________, a student at
_________________________________________ School, to attend Rutgers Model United Nations from 3-6
December 2015. I understand that Rutgers Model United Nations is a program of The Institute for Domestic &
International Affairs, Inc. (IDIA), a non-profit corporation in the State of New Jersey.
As the parent/guardian of the above student, I understand that the students school board is responsible for arranging
transportation to and from the conference facility. I further understand that the students school board and/or Faculty
Advisor remain responsible for my child at all times during the Rutgers Model United Nations experience and that
IDIA does not assume this responsibility. I am aware that my son/daughter may be leaving the Hyatt Regency New
Brunswick Hotel or Heldrich Hotel for meals and/or activities and give my permission accordingly.
I grant unlimited permission to the conference sponsors, to use, publish, and republish for purposes of advertisement
and trade and for uses it may determine, information and reproductions of my childs likeness and statements related to
my childs involvement with Rutgers Model United Nations. I understand that such uses will not identify my child
wherever possible.
I have reviewed the following rules and regulations with my child and agree that in the event that ANY of the rules are
broken, my child will be immediately dismissed from the Rutgers Model United Nations program. Should such a
dismissal occur, I understand that I will be required to IMMEDIATELY pick up my child from the conference facility
at my own cost.
Polices and Code of Conduct
!

The use and/or possession of narcotic drugs is strictly prohibited under federal and state law. Any student found possessing or
using an illegal substance will be reported to their Faculty Advisor and immediately removed from Rutgers Model United
Nations.

The legal drinking age in the state of New Jersey is twenty-one. Accordingly, no student may possess or consume any
alcoholic beverage. Any violation of this rule will result in the notification of the participants Faculty Advisor and the
students immediate removal from the conference.

IDIA may, at its discretion, contact the New Brunswick Police Department to report violations of the above two rules.

I understand that in the event of an emergency, I will be contacted as soon as is reasonably possible at the number(s) I
have listed below. In the event that I cannot be reached, I authorize all necessary medical attention to be provided for
my child. If my child has any known allergies or medical conditions, I have listed them below. I understand that this
information will be kept confidential and will be referred to only in the event of an emergency.
_____________________________
Signature of Parent/Guardian

_____________
Date

_________________________
Email

(_____)_______________________
Parent/Guardian Day Phone Number

(_____)_______________________
Parent/Guardian Evening Phone Number

As a student participant at Rutgers Model United Nations, I agree to follow all of the above rules and fully understand
the penalties for non-compliance.
_____________________________
Signature of Student Participant

_____________
Date

_________________________
Email

My child has the following known allergies, dietary needs, or other special medical conditions or requirements (list on
back as necessary):