Mark your calendar! LEADERSHIP POD PARTY
TUESDAY, APRIL 25, 2017 @ 5:30p - 8p
The PODS will all be together for an end of the year POD party!
Smyrna Community Center
200 Village Green Cir SE
Smyrna, GA 30080
Student Name *
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Student Phone Number *
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Have YOU attended your local C5 Leadership Pod meetings? *
Will you be attending the end of year POD Party? *
I will donate *
Parent/Guardian Name *
Your answer
Parent/Guardian Emergency Contact Phone Number *
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Parent/Guardian Emergency Contact Email *
Your answer
I give permission for my student to attend this C5 Georgia event and participate in all activities. By signing this permission slip, I hereby release and hold harmless C5 Georgia Youth Foundation, its directors, officers, employees, agents, and representatives, from any and all damages, claims, injuries, and liabilities of whatever kind, including but not limited to claims of bodily injury and loss or damage to personal property, which may arise out of my student’s attendance at this event and out of his/her participation in any activities while in attendance. Emergency Authorization: I hereby give permission to the medical personnel selected by C5 Georgia Youth Foundation to order x-rays, routine tests, and treatment of my child in the event I cannot be reached in an emergency, I hereby give permission to the physician selected by C5 Georgia Youth Foundation to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for my student as named above. *
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