The Northwest School s2

Parental Permission/Release Form for Northwest School Outing

NAME OF TRIP: Cross-Country Skiing at Iron Horse State Park in the Snoqualmie Pass Area

DATE OF TRIP: Saturday, January 9, 2016

LEADER(S): Jeff Blair and Joe Bisignano

PARTICIPANT’S NAME (Please Print) ______GRADE____

In consideration of the benefits to be derived, and in view of the fact that the Northwest School is an educational institution, participation in the programs of which is voluntary, and having full confidence that precautions will be taken to ensure the safety and well-being of my self/child/ward during this activity, I hereby agree to my/his/her participation in this activity/trip and waive all claims against the leaders of this activity/trip and the officers, agents, and representatives of the Northwest School. It is understood that, in the event of a serious illness or injury, reasonable efforts to reach me will be attempted. If I cannot be reached, I give my permission for my child/ward to be treated in a hospital or clinic.

Parent Signature ______Date______

Name (Please Print) ______

Phone numbers where Parent/Guardian can be reached during the time of this activity/trip. (Please list two):

__(____)______or (____)______

The Northwest School 1415 Summit Ave. Seattle, WA 98122 (206)682-7309 fax (206)467-7353 www.northwestschool.org