Metrocon www.AnimeMetro.com   Date:  July 18-20 (Friday-Sunday) Leaving:  6:30am Friday Returning:  7:00 pm (approximately) Meeting place:  Countryside High School Location: Crowne Plaza Hotel              10221 Princess Palm Ave.               TAMPA, FL  33610             Local Phone: 0001-813-6236363 Number of people per room: 4 Chaperones: 3 Cost: $77 (all money will be reimbursed when enough money is made from fundraising) What to bring:  - Clothes for 2 days -         Toiletries -         Spending and food money -         Camera -         Art work -         Costumes Note:  If someone who is not in the Japanese Club at Countryside High School, however old or young they are, is interested in going on this trip, they just need a copy of this form to fill out and then they can send it and the money to me.  Sarah Michael, 20 Village lane, Safety Harbor, FL, 34695.  They may also participate in fundraisers. Form and money Due June 4th.  We will be registered to go by May 20th.  After that date if you would still like to go, call me, Sarah Michael, at (727) 725-2425, and I will let you know if we still have room.    Name (first & last):__________________________________ Home Phone: (_____)__________   Street Address: ___________________________________________            Gender: M___   F___   City:______________________________________ State:___________   Zip Code:__________   Guardian�s Name:__________________________________ Work Phone: (_____)___________   Guardian�s Name: _________________________________ Work Phone:(_____)____________   Emergency Contact:   Name: _______________________________________  Phone Number: (_____)____________   Health Problems: ______________________________________________________________________________   Medication: ______________________________________________________________________________   Special Needs: ______________________________________________________________________________   Comments: ______________________________________________________________________________   ______________________________________________________________________________   ______________________________________________________________________________   ______________________________________________________________________________   ______________________________________________________________________________   The Metrocon trip is not through the school because Countryside High School will not acknowledge our club so late in the year.  This form is simply to ensure the safety of your child if an accident does occur.  We encourage that the members of the Japanese Club use common sense and safety precautions during the trip.  Individual members shall be responsible for their own actions.  The Japanese Club will not be held liable.    I herby give consent for my child to attend this event:   Signature:___________________________________________  Date:________________   Student Signature:_____________________________________  Date:_________________   Yes!  I am interested in chaperoning  []                      No.  I am not interested.  []

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