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Powers School ( ) Loomis School ( ) Penryn School ( ) Placer School ( ) Ophir ___________________________________________________________ has the opportunity to take part in school activities away from school. Participation in these events is purely voluntary and requires your written permission. If you approve the following arrangements, please sign at the bottom and return the form to the faculty sponsor or coach. I understand and acknowledge that Education Code Section 35330 provides that all persons making the field trip or excursion shall be deemed to have waived all claims against the District or the State of California for injury, accident, illness or death occurring during or by reason of the field trip or excursion. NATURE OF ACTIVITY: ( ) All Athletic Activities during current school year ( X ) Other (indicate activity) 8th grade promotion event DESTINATION: SunSplash in Roseville DATE: June 7, 2011 TIME OF DEPARTURE: 9:30 a.m. TIME OF RETURN: 3:00 p.m MEANS OF TRANSPORTATION: (Sponsor, please check) A. School bus _____X___ D. Walking __________ B. District owned vehicle _________ E. Bicycle __________ C. Commercial carrier _________ TRIP SUPERVISOR: 8th grade teachers I further agree in the case of medical emergency, illness, or injury that the supervisor has my express permission to take the above names student to a doctor or medical facility to receive emergency treatment. _______________________________ __________________________________________________ (Date) (Signature of Parent or Guardian) IMPORTANT MEDICAL INFORMATION THE SUPERVISOR SHOULD KNOW: Insurance: ________________________________________ Policy Number: _____________________________ EMERGENCY PHONE NUMBERS: _____________________________________________________________ FOR ATHLETIC EVENTS: THIS FORM MUST BE COMPLETED PRIOR TO THE ISSUANCE OF A CLEARANCE CARD. FOR OTHER ACTIVITIES: THIS FORM MUST BE COMPLETED FOR EACH ACTIVITY AND SUBMITTED FIVE SCHOOL DAYS BEFORE THE SCHEDULED EVENT. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PARENTS AND STUDENTS PLEASE NOTE: Permission slip and money must be turned in TOGETHER. Checks should be payable to your school s P.T.C., unless you attend Franklin. Franklin checks should be payable to Franklin School. Permission slip and money are due on or before May 26th. TOTAL COST: $26.00 (Discounted admission $14.50, lunch $6.00, unlimited drinks $2.50, transportation $3.00) ╢ aNт1иг06<BHNTZ`fДШ    √   о   Щ   Н   Й   И   ■   ¤    Table NormalNo List Balloon TextFаNт1иг`~Км╛ш*6jvШд╥▐╛ ╠ м ╛ ▄ ш :О "Ё$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"Ё╙[0ЁР $КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И7 DК ""рМ0МФ& "J╫$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"J╫DК "   "|╛0╛4"┌dФ& "Ё∙$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"Ё∙DК "  01Щ0 "|╛$КИИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"|╛DК "╠:01Р $КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И7 DК "9"01Ц* "Ё$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И7 9"ЁDК ""01Ёя▄ "Ё$К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 9"Ё  0Ёя▄ "Ё$К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 9"ЁЁ 0Ё╞О "Ё$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"Ё0ЁО "Ё$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"Ё0ЁУ$ "рМ$КИИИИИИИИИ И И И И ИИИ И ИИИ И ИИИ ИИ,И9"рМ0МЦ█Nт1иг`pАРа░└╨рЁ 0@.  0@P`Ж    С|    С|    С|    С|    С|    С|    С|    С|    С|    С|    С|    С|    С|    С|э╨ $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7  $Кэ╨ $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7                      Т  "рМ$КИИИИИИИИИ И И И И ИИИ ИИИ И ИИИ ИИ,И9"рМИ  "ble to your school s P.T.C., unless yo2:Ь╞╚V─╞xzЁЄ Т  V X  Д Ж ъ Д ъ ю Є F H юЁШ(*авдln ╪┌╪┌╘Ж0т°°°°°°ЇЇЇЇЇЇЇЇЇЇжЇжЇЇЇЬЇЇЇЇФЇЇЇЇЇЇЇЇЇЇЇЇЇЇЇЇЇЇЇЇМ° "Ё∙N"и) "Г№  "°|2В'(КИ °|WК""╖Ё" ─(╪" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>" ─╚─Єр╝р$ " $К И7 >"  " $К И>" Є $▄ " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >"  ╘ ╓ ┌  р╝Ф╝р( " $К И>" $" $К И>"  " $К И>"  $▄ " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >"  T р " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" T V $▄ " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" V X р " $К И>" X d (╪" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>" d Ф $▄" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>" Ф ╝ (╪" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>" ╝ т $▄" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>" т  (╪" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>"   $▄" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>"   (╪" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>"   м о Ж ь Є    : F *р╝рЬрМx`xМр" >" " >" " >"  " $К И>" $" $К И>"  " $К И>" *Ь(╪" $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И>" Ь р " $К И>"  H р " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" HJ$▄ " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" J┌р " $К И>" ┌ р " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" ╘N\rдД\Д8Д$ " $К И7 >" ( " $К И7 >"  " $К И>" \" $КJИИИИИ И,И>" rЖ р " $К╞ИИИИИИИИИ И И И И ИИИИИИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" ЖРТЇ0тр╕Ф╕xр "PS" 9"PS>" $ " $К И7 >" ( " $К И7 >"  " $К И>" ttт0─Є T V X d Ф ╝ т    *Ь HJ┌rЖт2468:<>@BDFHJLNPRTVXZ\^`b▐┐.т1ЎгlРд╢╚╪ъ■"2FbtМв┤▄Ё*@Zl~Т║Times New RomanSylfaenMangalVrinda Raavi Shruti Sandnya LathaGautamiTungaKartika Angsana NewBatang MS MinchoPMingLiUSimSunEstrangelo EdessaMV Boli Arial NarrowN Courier NewOSherwoodP StageCoachQTahomaRSymbolSendnyaSBookman Old StyleTAlbertus MediumU ё " "°|В"L+"\-"/"30"╓┐i"fК"cН"cН"cН "cН "5%  """  ""5%"К "№   *""    " "    "    ВИИИИИИИИИИИИИИ И!И"И#И$И%И&И'И(И)И*И+И,И7 >" °    FDPCFDPCNFDPCFDPCPFDPCFDPCRFDPCFDPCTFDPCFDPCVFDPCFDPCXFDPCFDPCZFDPCFDPC\FDPCFDPC^FDPCFDPC`FDPCFDPCbSYIDSYIDd SGP SGP dINK INK dBTEPPLC dBTECPLC ,d╪FONTFONTeЄSTRSPLC ЎgMCLDMCLDhЮPL PL ▓h6