8/13/2019 Theater for Social Justice (Packet)

1/3

Please save your space by submitting a

completed trip slip. The RSVP deadline is

Wednesday, March 12. Please turn this in

texting a photo of the form to 323-364 emailing a scan or photo of the form t

Sunday, March 160 am - 2 pm (9 am - 3 pm with transportation)

Zimmer Childrens Museum

Create theater about issues that are important to you

Meet new people from all of Los Angeles Be creative and have fun

Transportation and lunch will be provided.

forSocialJustice

Theater

8/13/2019 Theater for Social Justice (Packet)

2/3

A program of the Zimmer Childrens Museum6505 Wilshire Boulevard 100 Los Angeles, CA 90048

Phone: (323) 761-8311 Fax: (323) 761-8990www.youthink.org

RETURN THIS NO LATER THANWednesday, March 12, 2014

Engaging Students in Contempo rary Issues and Civic ction Through rtyouTHink Field Trip Permission Form

I hereby grant permission for my child to participate in the following event:

Destination: Theater for Social JusticeZimmer Childrens Museum6505 Wilshire Boulevard, 100Los Angeles, CA 90048

Date: March, 16, 2014Departure Time: 9:00 am Return Time: 3:00 pmI understand that transportation will be by: Shuttle / Bus .

youTHink Staff will call participating students a few days before the event to confirm the pickup times, pickuplocation 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, thatunanticipated situations and problems can arise on any trip, which situations or problems are not reasonablywithin 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 ZimmerChildrens Museum staff (including volunteers) are not to be held legally responsible in the event of accident orinjury 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 thisfieldtrip. I also give my permission for photos of my child taken while participating in youTHink programs to beused in promotional materials for youTHink and the Zimmer Childrens Museum, which may include aninstitutional 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 phonenumber) _______

Students name: __________________________ School: _________________________________________Address: _________________________________ City, State, Zip: __________________________________Grade: _____ Birth date: _____________ Email: ________________________________________________Students Cell Number: _______________________________ Home Number: _________________________Parent/Guardians Signature: ______________________________Print Parent/Guardians Name: _____________________________________

Please note: Submitting a permissionslip does NOT guarantee your childsparticipation at the event. Space islimited and youTHink Staff reserves theright to select students based ontransportation capacity and otherprogram considerations.

http://www.youthink.org/http://www.youthink.org/

8/13/2019 Theater for Social Justice (Packet)

3/3

6505 Wilshire Boulevard 100 Los ngeles, CA 90048Telfono: (323) 761-8311 Fax: (323) 761-8990www.youthink.org

ENTREGAR ESTA FORMA ANTES DELMircoles, 12 de Marzo, 2014

Iniciando a Los Estudiantes En Temas Modernos y Accin Cvica a Travs de ArtePermiso para el paseo con youTHink

Yo/Nosotros otorgamos permiso para que mi hija/hijo participe en el evento:

Destino: Teatro por la Justicia SocialZimmer Childrens Museum6505 Wilshire Boulevard, 100Los Angeles, CA 90048

Fecha: Domingo, 16 de Marzo, del 2014Hora de Salida: 9:00 am Hora de Regreso:3:00 pmEntendemos que el transporte ser a travs de: Autobs/CaminPersonal de youTHink llamar a los estudiantes participantes unos das antes del evento para confirmarlas horas de recoleccin, el lugar de recoleccin, y otros detalles del viaje. Por favor, llamen a LucyMendez a 323-761-8318 o 323-364-3187 para detalles.

Entendemos se proporcionar supervisin adecuada y apropiada. Reconocemos sin embargo, quepueden surgir situaciones y problemas imprevistos en cualquier viaje, problemas que no estn bajo elcontrol del supervisor de youTHink o del Museo Infantil Zimmer (incluyendo sus voluntarios). En talescasos, 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 deaccidente 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 unaemergencia durante este paseo. Yo/Nosotros tambin otorgamos permiso de utilizar fotografas tomadasdurante este paseo para publicaciones y materiales promocinales de youTHink y del Museo InfantilZimmer, al igual que videos institucionales, pgina de Internet folletos y ocasionalmente peridicos.

Durante el paseo, podr ser contactada/o al: En un caso de emergencia enel que no sea posible contactar a padres/guardianes, favor de llamar a al nmero

(como esta relacionada esta persona? To? Ta? Abuela? Etc.)

Nombre del estudiante: Escuela: ____________Domicilio: __ Ciudad, Estado, Cdigo Postal: ___________________________Grado: ______ Correo Electrnico: _______________________ Fecha de nacimiento: ______________Nmero celular de estudiante: ___ Nmero telefnico: ____________Nombre en imprenta de padre/guardin: ____________Firma de padre/guardin: ________________________

Por favortenga en cuenta que presentar una

forma de permisoNOgarantiza la participacin

de su hijo/a en el evento. El personal youTHink,

reserva el derecho de seleccionar a los

estudiantes en base de la capacidad del

transporte y los objetivos del evento.

http://www.youthink.org/http://www.youthink.org/