After School Art Club Permission Slip

After School Garden Club Permission Slip______

I give my child ______permission to participate in the (Student name) after school Garden Club. I understand the club will meet on the days and times as indicated below. Clubs will not meet when school is not in session.

Club Rules: 1 1. K, 1st and 2nd graders will meet every other Tuesday from 3:30-4:30 at the 2 gardens, if it’s raining or bad weather, we will meet in the science room. 3 3rd, 4th and 5th graders will meet every other Thursday from 3:30-4:30 at the 4 gardens, if it’s raining or bad weather we will meet in the auditorium. 5 6 2. Courtesy will be shown at all times, to fellow students and instructors.

7 3. Walk throughout the garden area, no running or horse play. 8 . 9 4. Garden tools will be kept below the waist with sharp points facing down. 10 11 5. Students will ask permission before picking, harvesting or eating anything in or 12 around the garden area 13 . 14 6. No squashing or killing any insects, worms etc. in or around the garden. Many 15 insects are beneficial to the garden. 16 17 7. Conserve water.

18 8. Each person will be responsible for keeping track of his or her tool or tools. 19 When finished they will clean their tool or tools and store them in the 20 designated area. 21 22 9. Gardening can be a dirty hobby, especially with children, parents please be 23 sure your child is not wearing clothes that could be ruined by getting dirt or 24 mud on them on the days the garden club meets. 25 26 10.This is a learning experience, questions are encouraged. The more we ask the 27 more we can learn. 28 29 11. Parents, Grandparents are always invited to join in. Just let me know ahead of 30 time if you will be joining us and are not a scheduled volunteer. 31 32 12. Parents will be responsible for getting their child to and from the meeting. All students must be picked up at 4:30, unless they are in the after school program then those students will return to the cafeteria to be picked up as usual. Student Address and Parent Contact information:

Student Name:______Student Gender (circle one): Male Female Student Age: ______Student DOB: ______Student Grade: ______Teacher______Address: ______Student Allergies (especially any food, plant or insect)______Student Special needs or concerns______Guardian Name: ______Guardian phone: (Home)______(Work)______(Cell)______Emergency Contact Name: ______Emergency Contact # ______E-mail (home): ______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 Christine Bonner 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 Christine Bonner while in attendance at the Garden club. In connection herewith, Christine Bonner agrees that she will 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) *Please return the completed form to Christine Bonner (Garden Coordinator). My contact information: Phone 864-979-0759 or [email protected]