The Northwest School

Parental Permission/Release Form for Northwest School Outing

NAME OF TRIP: _ Mount St. Helens Hiking Trip______

DATE(S) OF TRIP: _ Friday-Saturday, September 22 - 24, 2017 __

LEADER(S): _ Glen Sterr, Renee Fredrickson, Nathan Franck and Olivia Heeter___

PARTICIPANT’S NAME (Please Print) _________________________________ GRADE____

In consideration of the benefits to be derived, and in view of the fact that The Northwest School is an educational institution, participation in the programs of which is voluntary, and having full confidence that precautions will be taken to ensure the safety and well-being of myself/child/ward during this activity, I hereby agree to my/his/her participation in this activity/trip and waive all claims against the leaders of this activity/trip and the officers, agents, and representatives of The Northwest School. It is understood that, in the event of a serious illness or injury, reasonable efforts to reach me will be attempted. If I cannot be reached, I give my permission for my child/ward to be treated in a hospital or clinic.

Parent Signature _________________________________ Date________________

Name (Please Print) _________________________________

Phone numbers where Parent/Guardian can be reached during the time of this activity/trip.

(Please list two):

__(____)____________________ or (____)_+_______________________

A Note Regarding Financial assistance for trip fees:

Students/families receiving financial assistance for school tuition automatically qualify for having the Outdoor Trip fees paid by the Northwest School Experience Fund.

Please check here if you are requesting this fee to be paid by the Experience Fund.

The Northwest School 1415 Summit Ave. Seattle, WA 98122 (206)682-7309 fax (206)467-7353 www.northwestschool.org