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 ____________________
