Professional Documents
Culture Documents
Date: Friday, January 31, 2014 Departure Time: 5:00 pm Return Time: 8:30 pm Shuttle / Bus
youTHink Staff will call participating students a few days before the event to confirm the pickup times, pickup location and other trip details. Please feel free to call Lucy Mendez at 323-761-8318 or 323-364-3187 for details. I understand that adequate and appropriate supervision will be provided. I recognize, however, that unanticipated situations and problems can arise on any trip, which situations or problems are not reasonably within the control of the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers). In such instances, I agree that the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) are not to be held legally responsible in the event of accident or injury and I will hold the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) harmless from any costs, liability, or related expenses. I give permission for emergency medical attention to be administered should that be necessary while on this fieldtrip. I also give my permission for photos of my child taken while participating in youTHink programs to be used in promotional materials for youTHink and the Zimmer Childrens Museum, which may include an institutional video, website, or brochures. Emergency Contact Information: During the fieldtrip, I can be reached at: If unable to contact parent/ guardian, in case of emergency, please call: (name, relationship and phone number) Students name: __________________________ Address: _________________________________ School: _______________________________________ City, State, Zip: ________________________________
Grade: _____ Birth date: _____________ Email: ______________________ _________________________ Students Cell Number: _______________________________ Home Number: ________________________ Parent/Guardians Signature: Print Parent/Guardians Name: ______________________________ _____________________________________
A program of the Zimmer Childrens Museum 6505 Wilshire Boulevard #100 Los Angeles, CA 90048 Phone: (323) 761-8311 Fax: (323) 761-8990 www.youthink.org
Fecha: Viernes 31 de Enero del 2014 Hora de Salida: 5:00 pm Hora de Retorno: 8:30 pm
Autobs/Camin
Personal de youTHink llamar a los estudiantes participantes unos das antes del evento para confirmar las horas de recoleccin, el lugar de recoleccin, y otros detalles del viaje. Por favor, llamen a Lucy Mendez a 323-761-8318 o 323-364-3187 para detalles. Entendemos se proporcionar supervisin adecuada y apropiada. Reconocemos sin embargo, que pueden surgir situaciones y problemas imprevistos en cualquier viaje, problemas que no estn bajo el control del supervisor de youTHink o del Museo Infantil Zimmer (incluyendo sus voluntarios). En tales casos, nosotros convenimos en que ni el Museo Infantil Zimmer ni el supervisor o los voluntarios de youTHink y/o del Museo Infantil Zimmer debern ser hechos legalmente responsables. En caso de accidente o herida, mantendremos a todo el personal de youTHink y/o el al Museo Infantil Zimmer (incluyendo a los voluntarios) libre de cualquier costo, obligacin, o gastos relacionados a este. Yo/Nosotros otorgamos permiso para que se administre cualquier atencin mdica en caso de una emergencia durante este paseo. Yo/Nosotros tambin otorgamos permiso de utilizar fotografas tomadas durante este paseo para publicaciones y materiales promocinales de youTHink y del Museo Infantil Zimmer, al igual que videos institucionales, pgina de Internet folletos y ocasionalmente peridicos. Durante el paseo, podr ser contactada/o al: el que no sea posible contactar a padres/guardianes, favor de llamar a (como esta relacionada esta persona? Nombre del estudiante: Domicilio: Escuela: En un caso de emergencia en al nmero To? Ta? Abuela? Etc.) ____________
Grado: ______ Correo electronico:_______________________ Fecha de nacimiento: ______________ Nmero celular de estudiante: Nombre en imprenta de padre/guardin: Firma de padre/guardin: ___ Nmero telefnico: ____________ ____________ ________________________
6505 Wilshire Boulevard #100 Los ngeles, CA 90048 Telfono: (323) 761-8311 Fax: (323) 761-8990 www.youthink.org