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: June 21, 2008 Bus Trip to New York City

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)