Queen of Peace High School

Student Permission Slip

 

Seton Hall University Model UN

South Orange, NJ

March 9, 2002

 

I request permission for  ____________________________________

To participate in the Seton Hall University Model UN. I recognize the extent of the reasonable and prudent responsibilities of the school as well as those of my son/daughter by set school regulations and policy.

 

In the event of an emergency all doctors require parental consent before administering treatment. In the event that I cannot be reached in an emergency, I hereby give my consent to have_______________________

Treated by a physician and/or hospital.

 

I certify that___________________________ is in good physical condition, or that I have listed any and all specific conditions on the back of the form.

 

Parent or Guardian’s Signature____________________ Date__________

 

Home Phone           _________________________

 

Emergency Phone          _________________________