PO Box 387, New Brunswick, NJ 08903 Ÿ modelun.com Ÿ idia.

net

STUDENT PERMISSION SLIP

I hereby give permission for my child _______________________________,

Sulphia Iqbal a student at
_________________________________________
South Brunswick High School, to attend Rutgers Model Congress from 4-7 April 2019. I
understand that Rutgers Model Congress 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 student’s school board is responsible for
arranging transportation to and from the conference facility. I further understand that the student’s school board
and/or Faculty Advisor remain responsible for my child at all times during Rutgers Model Congress experience and
that IDIA does not assume this responsibility. I am aware that my son/daughter may be leaving the Wyndham 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 child’s likeness and statements related
to my child’s involvement with Rutgers Model Congress. 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 Congress 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 Congress.
§ 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 participant’s Faculty
Advisor and the student’s 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.

iqbal.noorul@gmail.com
_____________________________ _____________
4/3/19 _________________________
Signature of Parent/Guardian Date Email

(_____)_______________________
848 219-4555 (_____)_______________________
Parent/Guardian Day Phone Number Parent/Guardian Evening Phone Number
As a student participant at Rutgers Model Congress, I agree to follow all of the above rules and fully understand the
penalties for non-compliance.

_____________________________ _____________
4/3/19 _________________________
10016305@sbstudents.org
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):