Mill Creek High School

Mill Creek High School After School Hours Activity Form

PART ONE: To Be Completed By Sponsor

ACTIVITY : Greater Atlanta Math Tournaments

LOCATION : North Gwinnett High (Oct-Feb); Norcross (March)

DATE : Oct 19; Nov 16, Jan 11, Feb 22, Mar 21

TEACHER IN CHARGE: Teresa Hunsucker

PART TWO: To Be Completed By Parent/Guardian.

I give my son/daughter (student)______permission to participate in this school activity. YES NO

Describe below any medical conditions or currently prescribed medications that the sponsoring teacherThis should form be made should aware be ofused for forthis schoolactivity. sponsored Please list anyactivities emergency taking medication place that needs to accompany afterstudent. regular school hours or on weekends. ______

If medication needs to accompany student, an Administration of Medication Request Form must be filled out and given with the needed medicine in an original container to the teacher, who will be responsible for it.

I agree to assume responsibility for any unforeseen accident that might occur during travel or participation in this activity. I also authorize any emergency medical treatment that may-be necessary. I further recognize that students on school trips must adhere to the same code of behaviors as if they were on the school campus and are to follow the instructions of teachers, sponsors, bus drivers, chaperones, etc.

NAME OF PARENT/GUARDIAN(PRINT)______

SIGNATURE OF PARENT/GUARDIAN______

DATE______

HOME PHONE #______WORK PHONE #______

EMERGENCY CONTACT (IF NECESSARY)______

EMERGENCY CONTACT PHONE # ______