|Please return this form by Sunday 5/21/17
For further information or concerns, call (312) 816-1320
|Hyde Park Constellations
Permission for off campus activities
I hereby grant permission for my child ___________________________ (age) ________
Address: ________________________________ Apt # ______________
City ______________________________ State _____________ Zip ____________
to attend the activity listed below:
Hyde Park Constellations Annual Camping Skills Weekend at The Environmental Learning Center,
Will County Forest Preserve, 20851 S. Briarwood Lane, Mokena, IL 60448 (Cleveland Road
|Drop off Date & Time: Friday 6/16/17 at 4:00pm
Location: Hyde Park SDA Church, 4608 S. Drexel
Pick up Date & Time: Sunday 6/18/17 5:30pm
Location: Cubesmart Storage 407 E 25th St. 60616
Fee: Please be current with dues!
If you are dropping off your child, be sure to sign the waiver before leaving or your child
will not be able to participate.
|Permission for transportation: In the event where the club provides transportation, I consent for my
child to be transported to and/or from the above stated activities. The vehicle may/may not be
owned by the person driving it.
In the event I cannot be reached in an emergency, I hereby give permission to the physician
selected by Verdell Williamson-Porter, Director or adult designee in charge, to hospitalize, secure
proper anesthesia, or to order injection or surgery for my child/ward.
Last Tetanus ___________________________________________________________
Special concerns/conditions ______________________________________________
Please send all medications including inhalers with your child and be sure to inform the director/club
staff member in charge.
Parent/Guardian Signature Date
Phone number you can be reached at _____________________________________
Alternate number _____________________________________________________
Name (if other than yourself) ___________________________________________