Trip to Tallahassee for Children’s Week Activities

Please complete the following survey for your child's eligibility for the trip to Tallahassee.

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* 1. I, __________________________________, the parent or guardian of _________________________________hereby authorize and give consent to The Children’s Trust of Miami-Dade County for my child to participate in the Youth Advisory Committee (YAC) Tallahassee Leadership and Advocacy Tour occurring October 21, 2019.

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* 2. All expenses for transportation, lodging and meals associated with this trip will be paid by The Children’s Trust.


With regard to the participation of my child in The Children’s Trust Advisory Committee trip to Tallahassee as well as transportation to and from said event, I hereby waive any and all present and future claims I may have against The Children’s Trust of Miami-Dade County, it’s staff, service providers, employees, agents, affiliates and board members. 


My child has the following medical condition ___________________.  I have provided the medication necessary for the timeframe involved (please provide any documentation/ explanation as necessary).


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* 3. Parent/Guardian Print, Sign and Date

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* 4. Parent/ Guardian Emergency Phone Number (s)

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* 5. YAC Member Print, Sign and Date

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