The Empowerment Project Permission Slip for College Tours

(Students 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 and participate in any and all activities, along with other participants from The Empowerment Project. In consideration of such child being permitted to make such trips and participate in workshops/trainings and take part in such activities and 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 trips and activities (excluding paid certified carriers) from any and all liability responsibilities for making such trip and activities and hereby release all of the said parties from all liability by reason of any accident or injury suffered by the said child while on the said trip or participating in such activities and I agree to indemnify and hold all said parties harmless 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. Students Name______________________________Address__________________________ School attending:_____________________________Grade___________________________ Parents Name_______________________________Phone number____________________ Academic Interest:___________________________________________________________ Hobbies and activities:________________________________________________________

Contact: Bobby Hill 903 504 1996 Kymberli Anderson 214 537 0453