Permission Slips

Instructions: print out page and fill out
registration form with title then with your teens
information  and return to the teen program.

Trip:____________________________________________________________

Name: ______________________________________________M[] F[] AGE______

ADDRESS____________________________CITY__________ZIP______________

PHONE#_____________________________ EMERGENCY#__________________

SPECIAL INFO:_______________________________________________________
_____________________________________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of
any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with
participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

Signature_______________________________ Date__________________________