Don Quixote Permission Slip

Date: _______
Family Field Trip Permission Form

I,____________________________, parent/guardian of student(s) enrolled in OHDELA
do hereby grant permission for the following family members to attend the field trip to the Magical Theatre Company performance of Don Quixote on April 7, 2008 at 10:15 am.

List all family members’ names attending the field trip
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

In consideration of my family being allowed to participate in the field trip, I hereby assume all risks in connection with the field trip, and further release OHDELA, its staff and volunteers from all claims, judgments and liability for any injury or damage that my family may have due to participation in the field trip, including risks connected therewith foreseen and unforeseen.

Parent(s)/Guardians(s) Signature(and signature of all participants over 18 years of age)

________________________________________________________________________

Likeness Release Form

I, , give WHDL of Ohio, LLC (“WHDL”), and its affiliates, permission to use my, and all persons listed above, photo, image or likeness for the purpose of promoting the Ohio Distance and Electronic Learning Academy that WHDL manages. The permission and authorization to use my photo, image and likeness is voluntary and without consideration of any kind, and is a result of my support for OHDELA’s educational program.

Parent(s)/Guardians(s) Signature(and signature of all participant over 18)

________________________________________________________________________

Emergency Contact Numbers for April 7, 2008:

____________________________________ __________________________
Contact Person/Relationship Phone number(s)

____________________________________ __________________________
Contact Person/Relationship Phone number(s)


Mail the completed form and check(s) to: OHDELA
121 South Main Street, Suite 102
Akron, Ohio 44308
Attn: Lori Sansone
Or fax the completed form to: 1-800-514-8227
Attn: Lori Sansone
To participate in this activity, the completed form must arrive at OHDELA by Friday, April 4, 2008.