Permission Slip

Challenge Day

Participation space in Challenge Day is limited!

Applications are accepted on a first-come, first served basis.

I give permission for my child to participate in the Challenge Day program. I understand that the event is not required and that my child’s participation is voluntary. I further understand that Challenge Day and the sponsoring school/organization, its officers, employees or agents assume no liability either directly or indirectly for injury or accident resulting from or in any way connected with this event.

I understand that the Challenge Day program will deal with a wide range of issues such as leadership, self-esteem, social oppression, drug abuse, violence, racism, and teasing. I also understand that the program will be fun, empowering, eye-opening, and emotional. I have read the attached letter and have discussed confidentially with my child and support his/her participation. I further understand that my child may be invited to participate in future Challenge Day programs at his/her school, that members of the print and film media may be present at this event, and that my child may be photographed, interviewed or quoted as a participant in this program.

I have carefully read this statement and fully understand its contents. I am aware that this is a release of liability of Challenge Day and the sponsoring school/organization, its officers, employees and agents.

I give permission for my child (print name) ______to participate in Challenge Day at Westerville North High School.

Student’s Grade ______If 9th grade, Student’s English teacher______

Student’s Advisory Teacher ______

Parent Name (please print) ______

Parent Signature ______

Phone Number (_____ ) ______

Email Address ______

Student ID # ______

Payment $______(The actual program cost is $35/student. All donations are appreciated.)

Please make checks payable to Westerville City Schools.


Challenge Day is Coming to Westerville North!

February 2015

Challenge Day is a powerful, life-changing program that addresses issues of isolation, racism, stereotypes, peer-pressure and bullying within the context of teen life. In this program, students are engaged in games, activities, group discussions, and trust-building exercises. Challenge Day empowers students to break down the walls of separation and increase understanding, tolerance, acceptance, friendship, and positive peer support. In the words of Mahatma Gahdhi, students are challenged to “be the change they wish to see in the world.”

Challenge Day is being presented for the cost of $35 to Westerville North students. Adult volunteers are also needed to act as facilitators in the program. To watch a short video about Challenge Day, please visit To volunteer, or for more information, please contact Jen Kirk (teacher) at .

Challenge Day is generously sponsored by numerous individuals, businesses and service organizations. If you would like to make a contribution to the program, checks may be made out to Westerville City Schools – Challenge Day and sent to Westerville North High School, 950 County Line Road, Westerville, OH 43082, attention Jen Kirk. All contributions are tax deductible and greatly appreciated!