Middle School and Teen Summer Trips - West Point

WEST POINT YOUTH SERVICES SUMMER TRIPS PERMISSION SLIP FOR EVENTS

(Sign-up/Register at Bldg. 500 one week prior to event/workshop)

(Permission slips must be turned in at least one week before trip or activity occurs)

NAME OF PARTICIPANT:

Please check appropriate box (s) of each trip your child will attend

Registration will not be completed unless money is received for the trips that indicate ($) one week prior to the event.

PLEASE INDICATE IN SPACE BELOW ANY MEDICAL CONSIDERATION(S) (IE: ALLERGIES, MEDICATIONS, ETC.) THAT WOULD EFFECT PARTICIPATION:

I,____________________________ , Parent/Guardian of ______________________________________,

give consent for an authorized Youth Services representative(s) to take my child listed above for medical and/or dental care in an emergency situation

where the child’s condition represents a serious or imminent threat to his or her life, health or well-being. I understand that a conscientious effort will be

made to notify me prior to such action and the expense, if any, will be borne by me. Treatment at an Army facility may be provided without additional

consent under the provision of AR 40-3, paragraph 2-24b.

(Printed Name of Parent/Guardian) (Signature of Parent/Guardian)

(Date) (Home Telephone) (Work Telephone)

EMERGENCY NOTIFICATION (ONLY IF YOU CANNOT BE REACHED FIRST)

(Printed Name) (Home Telephone) (Work Telephone)

West Point Youth Services does not carry supplemental insurance to pay medical costs in the event that child is injured while participating in our activities. Military

dependents are authorized care from Keller Army Community Hospital or CHAMPUS. Those not authorized care from Keller, or parent(s)/guardians(s) who desire additional

coverage, will need to make arrangements privately. 500 Washington Road, West Point NY (845) 938-8525/3727. Due to the age of our youth and the belief in helping foster

independence, YS eldtrips do not require that youth are in direct line of sight of adults at all times. Youth are required to utilize the buddy system when on eld trips and an

adult will always be available at a previously determined designated location. We will require that each pair or group of youth has at least one operational cell phone, and

that they have emergency numbers available. If you have questions or concerns regarding this, please contact Youth Services Management at 845-938-3727.

Middle School and Teen

Summer Trips

Middle School and Teen

Summer Trips

Youth Center, Bldg. 500

938-3727/3208

¨Swimming: June 12, 19, 26; July 3, 10, 17, 31; August 7, 1:30-4pm

¨($) Bowling: June 21, July 5, July 19, August 2, 1:30-4pm

¨($) Ice Skating: June 20, 4-8pm

¨($) Bronx Zoo: June 26, 9am-6pm

¨($) Games at the Castle: July 6, 11am-5pm

¨($) Maritime Aquarium: July 11, 9am-5pm