7/27/2019 BAMN permission slip for Nov. 19 March at University
of Michigan
1/1
STUDENT
Information:Name:_______________________________________________________________Address:_____________________________________________________________Phone
number: ____________________
Cell:_______________________________
Date of
Birth:_________________________________________________________
Parent/Guardian Information:Name of Parent or
Guardian:_____________________________________________Home
Phone:_____________ Cell:_____________
Work:______________________email address:
_________________________________________________________
In Case Of Emergency:Emergency contact:
Name:_______________________________________________Phone
Number:________________________________________________________Relationship
to Parent/Student:____________________________________________
Healthcare Insurance Provider and Number (if
applicable):_____________________________________________________________________
Please list any health conditions, allergies or
diet/mental/physical restrictions that your child may have and
medications that he/she maybe using to treat this condition.
Indicate if the child has your permission to take such medication
while attending the event. You may alsoinclude the name of the
hospital or doctor of your choice and their phone numbers.
____________________________________________________________________________________________________________
PERMISSION NOTICE :
My son/daughter _____________________________________________
has my permission to attend the March at the University of
MichiganAnn Arbor Tues. November 19th, 2013. I hereby agree to
indemnify and hold harmless and blameless the Coalition to Defend
Afrmative
Action and Integration and Immigrants Rights and Fight for
Equality By Any Means Necessary (BAMN), its ofcers, employees or
agentsfrom any and all liability from damages, loss or injuries,
either to person or property, which the said minor may sustain
while engaged in anyactivity conducted by or in connection with
BAMN including but not limited to transportation. I further certify
that I have legal custody byreason of the fact that I am the parent
or the legal guardian by court order. I further allege that the
said minor is physically able to participate inthe activity set
forth herein. I further agree in case of injury or illness or other
actions requiring parental permission, BAMN staff shall have
theauthority to act for me, in case I cannot be reached. I further
understand that in case of injury, serious illness, or in extreme
cases of disciplinaryaction, the BAMN staff will, if need be, send
home my son/daughter by the rst available transportation at my own
expense.
_____________________________________________
______________________PRINT Parent or Guardian Name Date
_____________________________________________Parents or
Guardians Signature
Coalition to Defend Afrmative Action, Integration, and Immigrant
Rights and Fight for Equality By Any Means Necessary
www.bamn.comInstragram:joinbamn facebook:bamn Twitter:@followbamn
[email protected] Liana: (313) 806-1485 Maria: (313) 980-7075
November 19th 2013
BAMN PARENTAL
PERMISSION SLIP:March at University of Michigan
In Ann Arbor. To Defend Afrmative Action and
Minority Political Rights and Win Immigrants Rights
Buses depart school beginning of 1st period, Nov. 19th. Students
will arrive in Ann Arbor,
take part in a mass meeting with students from across the
Detroit area, march across
campus, then have lunch (food provided) & return to school
between 2pm & 3pm.
This is a eld-trip coordinated, sponsored and chaperoned by The
Coalition to Defend
Afrmative Action, Integration and Immigrants Rights and Fight
for EqualityBy
Any Means Necessary (BAMN), the organization whose national
chairperson,Shanta
Driver, argued before the U.S. Supreme Courton Oct. 15th 2013 to
defend afrmative
action, minority political rights and win immigrant rights in
the caseSchuette v. BAMN
while over 2000 high school students from across the national
rallied outside the court.
(See pictures to right).
With the signed permission of your parent, you have the right to
be excuse from school
on Nov. 19th 2013 to participate in this private eld-trip at the
University of Michigan.
For questions please call the numbers at the bottom.
MARCH AT THE UNIVERSITY OF MICHIGAN
To Defend Afrmative Action & Minority Political Rights &
Win Immigrant Rights
