MTI SKATE BUS FORM

TRIP PERMISSION FORM: 2010 KOOTENAY SKATEBOARD SERIES

You are being asked to sign this consent form to permit your child to participate in a field trip/activity

being organized by 2010 KSS. We want to ensure that you are fully informed about the details of the

trip/activity and the risks that your child may be exposed to. If you have any questions or concerns,

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1. Destination:

2. Activity: Skateboarding

3. Date: April 10th

Departure Time:

Return Arrival Time: 9

4. Transportation: Bus provided by Mountain Transport Institute

6. Cost: Free

7. What Your Child Needs to Bring: Water, Snacks, Helmet

8. Special Requirements: no

If Yes, please describe:

9. Level of and Description of Dangers and Risks: This risk factor for this activity is considered: medium

Please provide signature below and return this section by

Please retain the rest of the permission form for your information.

Permissions:

I have carefully read this form and understand each part of it. I understand and accept the level and types of risks that

my child may be exposed to while participating in this trip/activity. I give ______________________________

permission to participate in this trip/activity. Name of child

__________________________________ ____________________

Signature of Parent/Guardian Date

__________________________________ __________________ _______________

Printed name of Parent/Guardian Telephone # (home) Emergency #

⁭ Yes, I can volunteer for this activity	Comments/Questions:
⁭ No, I can not volunteer for this activity

Medical Information: Any illnesses, allergies or disabilities requiring special attention: Yes / No. If Yes,

please describe:

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