4th of July Parade Permission Slip Form
Dear Parent or Guardian,

We are excited to announce that BGCGS was awarded the honor of Non-Profit of the Year by the Mount Shasta Chamber of Commerce!

As part of this honor we will be featured in the 4th of July parade in down town Mount Shasta on Tuesday, July 4, 2023 and we invite all members to participate.

Each member who participates will receive a free BGCGS t-shirt to wear in the parade and keep as a souvenir (Please note that quantity and sizing is limited but we will do are best to ensure that all participants get a t-shirt.)

DAY OF PARADE

Drop Off: All participant need to arrive at La Perla Cantina (903 S Mt. Shasta Blvd.) by 10:30 am to lineup for the parade. 

Pick Up: Pick up will be near the Pit Stop's Parking Lot (500 N. Mt. Shasta Blvd.) All participants will need to be picked up promptly following the end of the parade as we cannot stay waiting in the parking lot for a lengthy period of time (approximately 1:00 pm).


The following items or equipment will be needed:
Please have your child wear closed-toed shoes, sun screen, comfortable active clothing (including their Boys & Girls Club of Greater Shasta t-shirt) and bring a water bottle.

If you have any questions during this event, you may contact us directly at:
(530) 220-5055.

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Club Member First Name
Club Member Last Name
Preferred T-Shirt Size (youth sizing) 
If there are any allergies or medical conditions that we should be aware of, please list here: *
In the event of a medical emergency; I hereby give permission to the physician selected by the Supervising Staff Member to secure proper medical treatment, including hospitalization, anesthesia, injections or surgery for my child.
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Insurance Carrier *
 Policy or Group Number *
Child's Date of Birth *
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DD
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Emergency Contact Full Name *
Emergency Contact's Relation to Club Member *
Emergency Contact's Phone Number *
Emergency Contact's Alternative Phone Number
In consideration of the opportunity extended to my child by the Boys & Girls Club of Greater Shasta, I hereby release said Club & members of it's Board of Directors and Staff from all actions, damages, claims and demands in law or in equity, of every kind and character I may now or hereafter have against them. It is the policy of the Boys & Girls Club of Greater Shasta in case of illness, accident, or other emergency affecting any member while at, or in route to or from an activity, to make every reasonable attempt to promptly contact the parent or guardian. *
Parent/Guardian First Name (Acting as Electronic Signature) *
Parent/Guardian Last Name (Acting as Electronic Signature) *
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