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Permission Slip – Halloween Night Party

I understand that this is a voluntary event. I give permission for my child __________________
to attend the Halloween Party at Empire Academy. This event will go from 3:30 pm until 10:00
pm for Jr. High students, and until 12:00 am for High School students, on Friday, October 31st,
2008. I understand that this is a closed-door event and my child will not be allowed to leave
unless their ride, specified below, is at Empire Academy to sign them out.
In the event of an apparent or real emergency in which medical treatment or hospitalization of my child may be necessary, the undersigned parent
or guardian does hereby authorize and appoint Empire Academy, through its agents, to obtain any medical treatment or hospitalization of the
above named child as they believe necessary and proper for the immediate care and welfare of said child. I do further authorize and direct any
medical doctor or hospital to render any and all treatment believed necessary and proper for the immediate care and welfare of the above named
child and the undersigned agrees to pay for such medical treatment and expenses incurred on behalf of such child and shall hold Empire Academy
and its agents harmless from any and all liability, claims, judgments and costs incurred in or as a result of any such medical treatment or
hospitalization.

Admission for this event is $10 or 1 bag of food for the Second
Harvest Food Bank Food Drive
Authorized Departure Time: ______________________________
My child will be driving him/herself home _____ yes _____ no
My child will be transported by ___________________________________ ______________
Name Phone

I can be reached at the following number on Halloween _________________________________


Parent Signature: ____________________________________________ Date: ______________

Permission Slip – Halloween Night Party


I understand that this is a voluntary event. I give permission for my child __________________
to attend the Halloween Party at Empire Academy. This event will go from 3:30 pm until 10:00
pm for Jr. High students, and until 12:00 am for High School students, on Friday, October 31st,
2008. I understand that this is a closed-door event and my child will not be allowed to leave
unless their ride, specified below, is at Empire Academy to sign them out.
In the event of an apparent or real emergency in which medical treatment or hospitalization of my child may be necessary, the undersigned parent
or guardian does hereby authorize and appoint Empire Academy, through its agents, to obtain any medical treatment or hospitalization of the
above named child as they believe necessary and proper for the immediate care and welfare of said child. I do further authorize and direct any
medical doctor or hospital to render any and all treatment believed necessary and proper for the immediate care and welfare of the above named
child and the undersigned agrees to pay for such medical treatment and expenses incurred on behalf of such child and shall hold Empire Academy
and its agents harmless from any and all liability, claims, judgments and costs incurred in or as a result of any such medical treatment or
hospitalization.

Admission for this event is $10 or 1 bag of food for the Second
Harvest Food Bank Food Drive
Authorized Departure Time: ______________________________
My child will be driving him/herself home _____ yes _____ no
My child will be transported by ___________________________________ ______________
Name Phone

I can be reached at the following number on Halloween _________________________________


Parent Signature: ____________________________________________ Date: ______________