Class of 2020 Senior Reflection Retreat

All Pilibos Seniors and select Pilibos faculty will embark on a retreat to AYF Camp in Valyermo, CA. Students will depart from campus on Friday, March 27 at 8:15 a.m. by bus and return on Sunday, March 29 in the afternoon.

My son/daughter, has my permission to attend the Senior Retreat at AYF Camp in Valyermo, CA from March 27-29. Transportation and Food will be provided for the duration of the retreat.
Name of Student Name of Student First Last
Phone Phone - ### - ### ####
Parent Information
Name of Parent Name of Parent First Last
Email
Phone Phone - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contacts
Name Name First Last
Phone Phone - ### - ### ####
Name Name First Last
Phone Phone - ### - ### ####
Name Name First Last
Phone Phone - ### - ### ####
Cost

The cost is $285.00/student, which includes transportation, lodging, food, t-shirt and various activities. This fee is due by March 6th, 2020. If you have any questions, please contact Mr. Andriassian sandriassian@pilibos.org
Price $ Dollars . Cents
AUTHORIZATION FOR MEDICAL CARE
Should it be necessary for my child to have medical care while participating in this trip, I hereby give the School personnel permission to use their judgment in obtaining medical care for the child, and I give permission to the physician selected by the School personnel to render medical care deemed necessary and appropriate by the physician. I understand that the School has no insurance covering such medical or hospital costs incurred by my child and, therefore, any cost incurred for such treatment shall be my responsibility.

Initial
By signing below, I understand that all persons taking a field trip or excursion shall be deemed to waive all claims against the school or the Board of Regents for injury, accident, illness, or death occurring during or by reason of the field trip or excursion. I agree to direct my child to cooperate with the directions and instructions of the school personnel in charge of the activity.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Class of 2020 Senior Reflection Retreat

Class of 2020 Senior Reflection Retreat

Parent Information

Emergency Contacts

Cost