e c a iler b day e e w k B at doc coastal cleanup

as part of

p U n a h Cle ach

Sat. Sept 21, 2013 8:00 am - 1:00pm

with transportation
Engaging Students in Contemporary Issues and Civic Action Through Art
Join us at Dockweiler Beach Tower 55 as we do our part to clean the oceanfront. Earn community service hours, meet new people, and feel great about helping the environment by keeping our beaches clean!

Transportation is available and lunch will be provided.

www.youthink.org
www.facebook.com/youthinkzimmer

For questions & to RSVP please contact: Carolina @ 323-761-8356; carolina@youthink.org youTHink is a program of the Zimmer Childrens Museum

Engaging Students in Contemporary Issues and Civic Action Through Art

youTHink Field Trip Permission Form I, _______________________, parent/ guardian of ___________________________ (student) hereby grant permission for our son/daughter to participate in the following event: Destination: Beach Clean-Up Dockweiler Beach Tower 55 12501 Vista Del Mar Playa del Rey, CA 90293

Date: Saturday, September 21st, 2013 Departure Time: 8:00 am Return Time: 1:00 pm Bus/Shuttle .

I understand that transportation will be by:

I understand that adequate and appropriate supervision will be provided. I recognize, however, that unanticipated situations and problems can arise on any trip, which situations or problems are not reasonably within the control of the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers). In such instances, I agree that the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) are not to be held legally responsible in the event of accident or injury and I will hold the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) harmless from any costs, liability, or expenses related thereto. I also give permission for emergency medical attention to be administered should that be necessary while on this fieldtrip. I also give my permission for photos of my child taken while participating in youTHink programs to be used in promotional materials for youTHink and the Zimmer Childrens Museum, which may include an institutional 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 phone number) Parent/Guardian(s) Signature: Print Parent/Guardian(s) Name: Date: _______________ Home Phone Number: _____________

Address:_________________________________________ City, State, Zip: _________________________

A program of the Zimmer Childrens Museum 6505 Wilshire Boulevard #100 Los Angeles, CA 90048 Phone: (323) 761-8311 Fax: (323) 761-8990 www.youthink.org

Engaging Students in Contemporary Issues and Civic Action Through Art

Formulario de permiso de paseo de youTHink Yo/Nosotros ________________________ los padres/guardianes de, una/un menor, comprendemos el tipo de viaje planeado a: Destino: Beach Clean-Up Dockweiler Beach Tower 55 12501 Vista Del Mar Playa del Rey, CA 90293 Sabado, 21 de Septiembre del 2013 8:00 am Hora de Retorno: __1:00 pm Autobus/Camion ,

Fecha:

Hora de Salida:

Entendemos que el transporte sera a traves de:

Entendemos que la supervisin adecuada y apropiada se proporcionar. Reconocemos, sin embargo, que situaciones y problemas imprevistos pueden surgir en cualquier viaje, problemas no razonablemente bajo el control del supervisor de youTHink/o Zimmer Childrens Museum (incluyendo voluntarios). En tales casos, nosotros concordamos que ni el Zimmer Childrens Museum ni el supervisante/s o voluntario/s de youTHink y/o Zimmer Childrens Museum debern ser tenidos legalmente responsable. En caso de accidente o herida, mantendremos al Zimmer Childrens Museum y todo personal de youTHink y/o el Zimmer Childrens Museum (incluyendo voluntarios) inocuo de cualquier costo, obligacin, o gastos relacionados a este. Yo/Nosotros otorgamos permiso de la administracin de cualquier atencin mdica en caso de una emergencia durante este paseo. Yo/Nosotros tambin otorgamos permiso de utilizar fotografas tomadas durante este paseo para publicaciones y materiales promocinales de youTHink y el Zimmer Childrens Museum, al igual que videos institucionales, pagina de Internet folletos, y ocasionalmente, peridicos. Durante el paseo, podr ser contactada/o al: padres/guardianes, en caso de emergencia, favor de llamar al relacionada esta persona? To? Ta? Abuela? Etc.) Si incapaz de contactar a _____(como esta

Firma de padre(s)/guardin(es): ____________________________ Fecha: ____________________ Nombre de padre(s)/guardin(es): _____________________ Numero telefnico: ____________________ Domicilio___________________________ Ciudad, Estado, Cdigo Postal: ___________________________

6505 Wilshire Boulevard #100 Los Angeles, CA 90048 Phone: (323) 761-8987 Fax: (323) 761-8990 www.youthink.org