OJJDP FY 2010 Strategic Enhancement to Mentoring Programs CFDA Number:16

Department of The Army U.S. Army Bull Dog Battalion, La Porte High School Junior ROTC Program, La Porte Independence School District 301 E. Fairmont Parkway, Texas 77571

Parent/Guardian Release/Permission Form Saint Edwards Park Orienteering Meet 3 October 2015 I give permission for my son/daughter ______(please print), who is currently enrolled in the La Porte Independent School District to attend the Saint Edwards Park Orienteering Meet on October 3rd at , Austin, TX . I fully understand that he/she will be under the supervision of the JROTC cadre, adults, and upper level cadets. I also accept full responsibility for his/her actions for the duration of this event and will not hold LPHS, the LPHS JROTC program, LPISD School Officials, and/or the LPISD School Board liable.

It is understood that all La Porte High School (LPISD) rules (conduct, zero tolerance, public displays of affection, etc.) are in effect for the duration of this activity. If a student should violate the school rules with any degree of severity, appropriate disciplinary action will be taken. Finally, I understand that my child will be unable to attend this event without this signed release form. Students will be transported from LPHS to the meet on Saturday at 4:00 AM, and will arrive back to LPHS on the same day at approximately 7:30 PM. Students must be picked up at this time by parent/guardian. All students must have a physical.

This form also serves as my authorization for emergency medical care should my child become sick or injured. I authorize Captain Antonio Hernandez, or members of the Booster Club to obtain emergency medical treatment if required.

Signature of Parent: ______Date: ______Signature of Student: ______Phone: ______Name and phone number of family doctor: ______Person to notify in case of emergency: ______Phone: ______Food Allergies: ______

INFORMATION (Detach and Keep for Your Information)

Activity: Saint Edwards Park Orienteering Meet Location: Saint Edwards Park, Austin, TX Cost: $6 for registration Departure: approximately 4:00 AM Arrival/Pick-up: approximately 7:30 PM Contact numbers: CPT Hernandez 281-604-7740, for emergency only 832-578-7872 [email protected] Space Center Blvd.

Last updated 9/17/15 11:09