Pali Institute Commitment Form for Portola HGM Group
****UPDATE*** 12/9/21: ANY FURTHER SUBMISSION WILL BE WAITLISTED***********************************

This is the PALI SIGN-UP FORM!

Please fill out this commitment form if you are planning on attending the Pali Institute trip in Running Springs during the weekend of May 13-15, 2022 with our parent-led group from Portola HGM.   Please complete this form by Wednesday December 8, 2021

The total cost is $450. The full non-refundable payment is due Wednesday December 15, 2021.  You will be invoiced via PayPal a few days prior to the due date.
Please contact portolhgmpa@gmail.com if you need an alternative payment system.

Information about the camp can be found at: https://www.paliinstitute.com/
and in this slideshow:  

https://docs.google.com/presentation/d/1b59aQdk0Bitl5q9sHw7dLMRecjHIKuUMb9ooc2L4ZYc/edit?usp=sharing


***This parent-led trip is not run by LAUSD, Portola, or Portola HGM***
Sign in to Google to save your progress. Learn more
Email *
Child's Name (First and last name) *
Child's Grade Level *
Child's gender (for purpose of room assignment) *
Child's date of birth (month/date/year) *
MM
/
DD
/
YYYY
Parent's Name *
Parent's email address *
Parent's phone number *
Emergency contact phone number(s) *
My child has permission to bring and use the following medications.
If necessary, parent chaperones and/or Pali staff may administer the above specified medications to my child
Clear selection
My child is allergic to the following food(s) and/or medications (please specify allergic reaction)
I acknowledge that my total payment of  $450 for this Pali Institute group trip is NON-REFUNDABLE. *
Required
I acknowledge that transportation to Pali Institute leaves on Friday May 13, 2022 3pm and returns Sunday May 15, 2022 around 3:30pm.   *
Required
I acknowledge that there is a risk for contracting COVID-19 and I accept that risk. I agree to take a COVID-19 PCR test 72 hours prior to departure for my child (and wait for negative results).  Additionally, I consent to any additional testing, including rapid COVID testing per Pali Institute policies. I agree to comply with Pali COVID-19 policies, including wearing masks. *
COVID-19 VACCINATION STATUS:    Is the student participant fully vaccinated against COVID-19?   *
I acknowledge that this is an optional non-LAUSD, non-Portola, non-HGM trip.  I acknowledge that my child must follow behavioral expectations for this trip, both at Pali and during the bus transportation to/from Pali.  I understand that if my child violates the behavioral policy, the participant will be dismissed from the program without refund AND the student must be immediately transported home by the parent/guardian.  Any damage to property or equipment, whether intentional or accidental, is subject to additional Pali Institute fees and is the responsibility of the parent/guardian. *
Required
Full or partial scholarships might be available depending on the number of applicants. Check this box if requesting financial assistance, which is not guaranteed.
Clear selection
CABIN REQUEST:  Please list up to 4 people you’d like to bunk with at PALI CAMP.  We will make every effort to place each student with at least 1 person that they’ve requested.  However, we must fit all students into cabins assigned by PALI CAMP and cannot guarantee rooming situations. If there is a student with whom you feel you cannot bunk, please let us know.  All requests of this nature will be kept strictly confidential and will be discarded after the field trip.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms