Parent Permission Form

  I, the undersigned parent/guardian, give permission for _________________________________ (print name of "the student") to participate in The Patched Overalls Experience (d/b/a name for Patched Overalls Scholarship).
  I understand that "the student" will be creating a proposal for a desired experience of the student's choosing.
  I am fully aware of what experience "the student" desires and will permit "the student" to partake in that experience should "the student" be awarded the Patched Overalls Scholarship.
  I am aware that "the student" will sign a Notice of Intent which states, that should "the student" be awarded the scholarship, "the student" will fulfill the obligations of keeping a journal while on the desired experience and sharing what was learned from the experience when "the student" returns to their home community.
  I understand and agree to sign the Release of Liability and Wavier should "the student" be awarded the Patched Overalls Scholarship and that no arrangements/bookings can be made until this form is signed and returned to Tyson Schaffner.
  I understand that should "the student" be awarded the Patched Overalls Scholarship, neither "the student" or I will receive any cash, check, or equivalent. All arrangements/bookings will be made by Tyson Schaffner, in cooperation with the parent/guardian, and paid directly to the appropriate entities not to exceed $2500.

 

Print Parent/Guardian Name

___________________________________

Parent/Guardian Signature

___________________________________

 

Date  ___________________________________

 

 

Notice of Intent to Fulfill Obligations

If I am awarded the Patched Overalls Scholarship, I, the undersigned student, agree to and intend to follow through with the obligations set forth here:


    1.) I agree to keep a journal while I am participating in my experience.

 

    2.) I agree to share what I learned during my experience with my community when I return home in any way that is

         deemed appropriate.

 

Print Name  ___________________________________

 

Student Signature __________________________________

 

Date ____________________

Click here to download Parent Permission and Notice of Intent to Fulfill Obligations Form

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