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WEST GOSHEN TOWNSHIP
PARENTAL/GUARDIAN PERMISSION FORM
Name of Participant(s) Under 18 Years of Age:_______________________________
__________________________________________________________________
Address:___________________________________________________________
Chaperone Accompanying Child(ren):_____________________________________
Recreation Activity and Date: April 18, 2000 Bus Trip to Gettysburg
I, the undersigned, as legal guardian for the participant(s) listed above, grant
permission for participation in the aforementioned event. The chaperone listed
above assumes responsibility for the listed child(ren) during the event.
____________________________ ____________________________
Signature of Parent or Guardian Date
____________________________
Signature of Chaperone
(if different from parent or guardian)
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