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Parental Permission Slip _______________________ Student’s Name

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Parental Permission Slip _______________________ Student’s Name
Parental Permission Slip
Student’s Name (Please Print): _______________________
I, the parent/guardian of the above-named student, hereby consent for my child
to accompany the Summer Youth College, of which he/she is a member, on any
local trips. I authorize Palm Beach State College to obtain, through a physician
of its own choice, any emergency medical treatment necessary for my child
in the course of such activities or such travel. I also agree not to hold Palm
Beach State College or anyone acting on its behalf responsible for any injury
occurring to the above named child in the course of such activities or such travel.
Parent Signature ________________________ Phone: _______________
Today’s Date ________________________
Please fax to: 561.862.4729 or send with your child the first day of class.
SUMMER YOUTH COLLEGE
Palm Beach State College
3000 Saint Lucie Avenue
CB 103 (Classroom Building B)
Boca Raton Florida 33431
561 862 4728
E-Mail: [email protected]
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