Chalice Northwest Unitarian Universalist Congregation
Promoting Religious Freedom, Spiritual Growth, and Ethical Action
  
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Permission Slip

Please print, sign, and return to DRE, Karen LoBracco.         

Nursery and Children and Youth Religious Education

    

 ACTIVITY PERMISSION STATEMENT 

Activity:  Field Trip to Sandy Springs Recycling Center, 470 Morgan Falls Rd, Sandy Springs 30350 (770-551-7766).  A light lunch of cheese pizza will be served.                 


 

Activity Date:  Sunday, May 6, 2007.   Leave Northwest about 10:50AM, return about 1PM.  Transportation will be in private automobiles.  Drivers must furnish valid license and current registration and proof of insurance.  Parents will be responsible for bringing and securing appropriate car seats.       


 

Cost:  FREE, but each person is asked to bring of bag of items to be recycled.


My son/daughter __________________________ has my permission to participate in the above activity under NWUUC supervision on the scheduled date(s).  With the understanding that NWUUC will assure that the activity is properly supervised, I hereby relive NWUUC, the leadership thereof, and the persons conducting this activity of any liability in connection with my son’s/daughter’s participation in this activity.  In the event of a medical emergency, I understand an attempt will be made to contact me at ________________ (phone no.).  If I cannot be reached in time, I hereby authorize the administration of emergency medical aid to my son/daughter.  (Please note any allergies or other medical problems on this form.)
Medical Insurance Co._____________________  Policy Number__________________
Known allergies to medications_____________________________________________
Known medical problems/conditions_________________________________________
Furthermore, my son/daughter and I have reviewed the policies printed on the reverse, and understand the consequences for infractions.
 
Please return this permission slip as soon as possible so we can assure a spot for each child that wants to attend!  Priority given to children of drivers, then according to when DRE receives this form.  This Field Trip is the only religious education program planned for May 6.
 
 
____YES, I can be a driver and chaperone!                   # of seatbelts in the rear of vehicle___



________________________________       
Signature of Parent/Guardian
 
 
________________________________
Signature of Child/Teen



Field Trips
 
For purposes of this policy, a field trip is any excursion in which children or youth under the care of volunteers or staff of Northwest’s Religious Education program leave Northwest’s premises.  There shall be no fewer than two adult chaperones on any Northwest field trip involving our youths.  If the group includes both boys and girls, at least one chaperon shall be male and one chaperon female.  There shall be no more than ten youths for every chaperon, and we will aim for a seven to one ratio.
Drivers under the age of 21 will be permitted only with written parental permission for both driver and passengers, and subject to the approval of the director of religious education or instructor in charge of the field trip.  All those traveling on a Northwest field trip shall be safely buckled up whenever they are in a moving vehicle.  The capacity of any vehicle used for Northwest field trips shall be equal to the number of working seat belts.
Rules that apply at the Chalice House apply on field trips, including prohibitions against smoking and the use of alcoholic beverages and illegal drugs.
No one will be permitted to participate in a field trip or lock-in without a permission form signed by parent or guardian.  The permission form is a release of liability and contains medical emergency information. Signed permission forms and a first-aid kit must accompany any field trips.
 
 

Lock-ins

 
All rules applying to field trips also apply to lock-ins, with these additional considerations.
At least one adult shall remain with the students at all times, and shall remain awake until all the lock-in participants have fallen asleep.
The lock-in group shall remain together at all times.  In cases where the group wants to leave the grounds, the chaperon(s) shall either have alerted parents ahead of time or shall post the destination and time of return on the front door of the Chalice House.
There shall be no visits from youths not participating in the lock-in.
All activities shall be open to all participants.  There shall be no exclusive activities, including expression of romantic involvement, between any of the lock-in participants.
Sleeping rules are simple: one student to a sleeping bag.
All participants will strictly abide by the instructions given by the chaperon(s).  Any youth who does not abide by the instructions will be given a warning.  If the behavior persists, the chaperon(s) will phone the youth’s parent(s) or other guardian and have the youth picked up.
In the event lock-in participants either bring a video with them or decide as a group to rent one for the evening, the chaperons shall have final say as to whether a movie is appropriate for the group, bearing in mind that maturity may vary significantly even among students of the same age.  When in doubt, chaperons shall err on the side of being too conservative.