Preschool - the YMCA of Greater Cleveland

YMCA OF GREATER CLEVELAND
2013 Lakewood YMCA SUMMER FIELD TRIP PERMISSION SLIP
June 10, 2013 – August 16, 2013
CHILD CARE LOCATION – YMCA Preschool Camp
(Program begins and ends at Grace Presbyterian Church)
BELOW IS THE INFORMATION AND PERMISSION SLIP FOR THE SCHEDULED FIELD TRIPS AND SWIMMING ACTIVITIES FOR SUMMER
DAY CAMP AT THE LAKEWOOD YMCA. BE SURE TO SIGN, DATE, AND INITIAL THE FORM. THIS PERMISSION SLIP MUST BE TURNED-
IN BEFORE YOUR CHILD MAY ATTEND CAMP FOR THE WEEK REGISTERED.
ALL PERMISSION SLIPS ARE DUE ON OR BEFORE MONDAY AT THE START OF CAMP. IF A FIELD TRIP IS CHANGED, YOU WILL
RECEIVE A CORRECTED FIELD TRIP PERMISSION SLIP FOR THAT PARTICULAR DAY & ACTIVITY.
FIELD TRIP PERMISSION:
DATE FIELD TRIP DESTINATION DEPARTURE
TIME
6/20/13 Olmsted Falls Park
26100 Bagley Road
Olmsted Falls, OH 44138
6/27/13 Great Lakes Science Center
601 Erieside Ave
Cleveland OH 44114
7/2/13 Children’s Museum
10730 Euclid Ave
Cleveland, OH 44106
7/11/13 Cleveland Zoo
3900 Wildlife Way
Cleveland, OH 44109
7/18/13 Bleser Park
32649 Electric Blvd
Avon Lake, OH 44012
APPROX.
RETURN
TIME
MODE OF
TRANSPORTATION
9am 4pm YMCA Bus
9am 4pm YMCA Bus
9am 4pm YMCA Bus
9am 4pm YMCA Bus
9am 4pm YMCA Bus
PARENT/
GUARDIAN
INITIALS
Avon Lake Public Library
“Discovery Works”
32521 Electric Blvd
Avon Lake, OH 44012
7/25/13 Pump It up
1758 Moore Road
Avon, OH 44011
8/1/13 Cleveland Botanical Gardens
11030 East Blvd
Cleveland, OH 44106
8/6/13 Lake Farm Park
8800 Chardon Road
Kirtland, OH 44094
8/15/13 Lakewood Park
14532 Lake Ave
Lakewood Ohio 44107
Daily
Rosewood Park
Rosewood Ave
Lakewood, OH 44107
Daily
Walking Field Trip;
Roosewood Ave or Westwood Ave
(sidewalks only)
9am 12pm YMCA Bus
9am 2pm YMCA Bus
9am 4pm YMCA Bus
9am 4pm YMCA Bus
9am
3pm
9am
3pm
Transportation services will be provided by (YMCA Staff check one):
YMCA owned/operated bus __x__  Leased bus with YMCA driver _____  Contracted bus services through school district _____
In any of the above field trips, will children have access to water that is two or more feet in depth? Yes ___ No _X_
If yes, list field trip destination(s): N/A
Are water activities planned in water that is two or more feet in depth? Yes _X_ No ___
If yes, complete swimming permission section:
12pm
5pm
12pm
5pm
Walk
Walk
REV 6/07

SWIMMING PERMISSION (CHECK APPROPRIATE ANSWER):
DATE FIELD TRIP DESTINATION DEPARTURE
TIME
6/12/13, 6/17/13,
6/19/13, 6/24/13,
6/26/13, 7/1/13,
7/3/13, 7/8/13,
7/10/13, 7/15/13,
7/17/13, 7/22/13,
7/24/13, 7/29/13,
8/2/13, 8/5/13,
8/7/13, 8/12/13,
8/14/13
Lakewood YMCA
16915 Detroit Ave
Lakewood, OH 44107
3 year old classroom
4 year old classroom
9am
12:30pm
APPROX.
RETURN
TIME
11:30am
3:15pm
MODE OF
TRANSPORTATION
YMCA Bus
YMCA Bus
PARENT/
GUARDIAN
INITIALS
1. MY CHILD IS A: SWIMMER _____ NON-SWIMMER _____
2. MY CHILD HAS PERMISSION TO PARTICIPATE IN WATER ACTIVITIES: YES _____ NO _____
Transportation services will be provided by (YMCA Staff check one):
x YMCA owned/operated bus  Leased bus with YMCA driver  Contracted bus services through school district
THE CENTER WILL NOT BE PROVIDING ADDITIONAL ADULTS OR STAFF MEMBERS
ABOVE THE RATIO REQUIREMENTS FOR THESE SWIMMING ACTIVITIES.
In the consideration of the opportunity for my child to be a participant in the YMCA of Greater Cleveland’s child care field
trip, I, the parent or guardian, hereby assume all risks and release and hold harmless the Association and all its members,
volunteers and employees from any claim that might arise as the result of my child’s participation in the field trip including
transportation related to the field trip. I have read the above and willingly consent to allow my child’s participation under the
above stated condition.
_________________________________________________
CHILD’S NAME
___________________
DATE OF BIRTH
_________________________________________
PARENT/GUARDIAN SIGNATURE
________________
DATE
REVISED: MAY 20, 2013
REV 6/07