PARENTAL PERMISSION FORM
Registration Deadline: April 8, 2016

The Oregon Writing Festival requires this signed form to be completed in order for a student to attend.

Please complete and return it to the teacher. 

***To be completed by parent or guardian***

Student’s Name:  _____________________________________________________________________________
			Last 				First				Middle initial

Grade: ___ Gender: ___ School: ____________________________________ District: ____________________
	
Name of Parent or Guardian: __________________________________________________________________

Address:  ___________________________________________________________________________________

City: _____________________________________________                  ZIP: ________________________   

Phone(s): ____________________________________      ___________________________________________

Please list any medical problems, handicapping conditions, allergies, food restrictions, etc. to ensure that your child has a safe and healthy day: ________________________________________________________________
_____________________________________________________________________________________________
Emergency Contact:  __________________________________________ Phone: _________________________
Physician’s Name:  ____________________________________________Phone: _________________________

In case of injury, I give permission for Oregon Writing Festival officials to arrange emergency care for my child.

Parent Signature: _____________________________________________________ Date: __________________

Please initial the boxes below to confirm your understanding of the following requirements:

       The school will provide my student with transportation to and from the Oregon Writing Festival
        
        I will provide my student with transportation and accompany him/her to the registration area at the Festival.

        I will provide a sack lunch for my student 

STUDENT WRITING ENTRY INFORMATION
***To be completed by student or teacher***

Title of Entry (optional): _______________________________________________________________
Approximate Length _____________________        Approximate Reading Time _________________  
If the piece is longer than 4 minutes, the student can only read some of it and summarize the rest.  
***You need to bring twelve copies of your writing to the Festival.***