I d a h o O r c h e s t r a I n s t i t u t e P e r m i s s i o n F o r m ??2017-05-22I d a h o O r c h e s t r a I n s t i t u t e P e r m i s s i o n F o r m S t u d en t ’ s Name: _____ P h o n e: _____ S t reet

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    12-May-2018

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  • IdahoOrchestraInstitutePermissionForm

    StudentsName:__________________________________Phone:____________________Street:___________________________________________________________City:______________State:____Zip:_______E-mail:______________________Parentsname(s):(ifunder18)_____________________________________________________Parentsphonenumber(s)___________________________________________Parentsemail(s)___________________________________________________InsuranceCompany:___________________________PolicyNo.:______________

    PermissionandMedicalTreatmentWaiver

    (Over18,filloutwithyourname)

    I,___________________________,theparent/guardianof______________________doherebygivemypermissionforhim/hertoattendIdahoOrchestraInstituteandtobetreatedforamedicalemergencyinmyabsencewhileparticipatinginIdahoOrchestraInstituteactivities.EmilyWhiteoranyassistantatIdahoOrchestraInstitutemayactasanagentinmyabsence.Incaseofaccident,IdonotholdIdahoOrchestraInstitute,SawtoothCamporanyofitsstaffersponsible.Incaseofemergency,ifIamnotavailableattheaboveaddressandphone,pleasecontact:Name:_____________________________________Phone:____________________Parent/GuardianSignature:_______________________________Date:___________SpecialDietaryNeeds:__________________________________________________Allergies:______________________________________________________________

    STUDENTAGREEMENT:

    IunderstandthatIamattendingIdahoOrchestraInstitute.Iagreetofollowanyandallrulesandparticipatetothebestofmyabilityinallcampactivities.IalsounderstandthatanyviolationofruleswillresultinmyimmediateexpulsionfromIdahoOrchestraInstituteandthatIwillbesenthomeatcosttomyparents/guardiansStudentsignature___________________________________Date__________________Parent/guardiansignature_____________________________Date__________________

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