After School Falcon Art Club Permission Slip

I give my child ______permission to participate in the (Student name)

After school Falcon Art Club. I understand the club will meet on the days and times as indicated on the informational packet calendar (usually on Tuesdays or Wednesdays, after school from 4:15-5 p.m. or longer depending on the project we are working on at the time). The art club will not meet when school is not in session (unless students are working on murals or workshops on or off- campus).

Club Rules: 1 1. Only students attending Eastlake High School can participate in the art club. 2 3 2. Participation in the club RULES: 1 • BEHAVIOR: The club sponsor may dismiss students from the art club due to misbehavior during after school sessions & after consultation with EHS administration. 2 • ATTENDANCE: Once a student has missed 3 sessions (or has not contributed or helped with murals/fundraisers/workshops), the club sponsor may choose to dismiss the student from participation in the art club. Please check type of transportation needed: _____Walks to and from school _____Parent pick-up _____Activity Bus My child may also ride home with: ______(No deviations without written instructions) Student Address and Parent Contact information: Student Name: ______Student Gender (circle one): Male Female Student Age: ______Student DOB: ______Student Grade: ______Address: ______Student Allergies:______Student Current Medications: ______Student Special Needs or Concerns:______Guardian Name: ______Guardian phone: (Home)______(Work)______(Cell)______Emergency Contact Name: ______Emergency Contact # ______E-mail (work) :______E-mail (home): ______Video Permission Slip: ______My child MAY watch PG rated movies.

______My child may NOT watch PG rated movies. FIELD TRIP PARTICIPATION

I give permission for ______to participate in art club field trips. I understand that I will be notified in advance and assume full responsibility for his/her participation. Transportation may need to be provided by the parent for any field trips/activities planned for the weekend or outside of school.

Picture/Video Authorization: During art club activities and field trips, we will be taking pictures and/or videos of our students. I will be making photo galleries with these pictures and may be sending some to the newspaper and some may be included on our web page. We would like your permission to include your child. I, ______, the lawful parent or guardian of ______give my permission to release any pictures taken of the above mentioned child, by the club volunteers to be included in any announcements, advertisements, and documents in the Eastlake High School Art Club name.

AUTHORIZATION AND CONSENT TO EMERGENCY MEDICAL TREATMENT

I, ______the lawful parent or guardian of ______, A minor child of whom I have custody and control, do hereby authorize the agents and employees of the SISD to procure such emergency medical treatment as may be reasonably necessary to provide for the health and well being of said minor child at any time that such minor is in the custody of said SISD employee while in attendance at school, in attendance at the Eastlake High School Art Club, or while en route to or from school from a field trip.

I further authorize the said agents or employees of the SISD to sign any and all consents required by physicians or hospitals in connection with said emergency treatment, including but not limited to the administration of anesthesia, disposal of tissue, the taking of photographs, moving pictures, television pictures, etc, the drawing of blood samples, and the performance of such additional operations or procedures as are considered necessary or desirable in the judgment of the attending physician or hospital authorities.

In connection herewith, the SISD agrees that it will direct its agents and employees to make a reasonable attempt to contact the parent or guardian of the child if emergency medical care or treatment is necessary and that the above authorization and consent is for the purpose of providing emergency care and treatment for the child when the parent or guardian cannot be located. ______Signature of Parent/Guardian Date

Other person to be notified: Name ______Phone______*Local phone # for emergency, please.

Date of last Tetanus Booster Shot: ______Insurance Carrier: ______Policy #______Doctor ______Phone # ______Hospital ______(Parent/Guardian Signature)