Middle School & High School at The Common Good
UPDATED SUMMER HOURS: June & July > 4:30-7PM
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Student Name *
First and last name
Student Phone number *
Student Date of Birth *
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What school do you currently attend?
What grade will you be in during the 2023-2024 school year?
Clear selection
This summer, I'm interested in coming to The HUB for: (you can check more than one!)
What other things would you like to do at The HUB this summer?
Parent / Guardian Name *
Parent / Guardian phone number *
Parent / Guardian email
 *
FOR PARENT/GUARDIAN: MEDICAL RELEASE & PARTICIPATION AUTHORIZATION

In case of emergency, I hereby give our (my) permission to take said participant to a doctor or hospital and hereby authorize medical treatment, including but not in limitation to emergency surgery or medical treatment, and assume the responsibility of all medical bills, if any.

Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.

This authorization and permission form is valid for all The Common Good activities for Summer 2023.

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FOR PARENT/GUARDIAN: IN CASE OF EMERGENCY, PLEASE PROVIDE MEDICAL INFO FOR FIRST RESPONDER
My child is currently taking the following medication & reason for taking medication:
FOR PARENT/GUARDIAN: FIELD TRIP PERMISSION
Participants in Summer programs may be participating in various field trips during specific days throughout the program.
By agreeing (marking 'YES'), I agree that my child(ren) has permission to be transported by any The Common Good partners to attend field trips during summer 2023. I understand that personal injury can and may occur to my child(ren), and I give permission for my child(ren) to receive emergency medical treatment if needed. I further agree to be liable for and to pay all costs incurred in connection with such medical attention. I hereby release The Common Good, its employee, volunteers, and agents thereof from any and all liability, claims, or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and child-participant that occurs while said child is participating in the field trip sponsored by The Common Good.  
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