Okinawa Christian School International 沖縄クリスチャンスクールインターナショナル Student Activity Permit The High School is going to Camp at Tokashiki Island on Wed. October 2, to Fri. October 4, 2013. Please fill out and sign the section below, indicating your student has your permission to attend High School Camp at Tokashiki Island. Please have your student return the bottom section to their homeroom teachers by Wednesday, September 25th. ________________________ Secondary Principal 高等学校校長 ******************************** Please cut here 切り取り線 ******************************** To: Okinawa Christian School International 沖縄クリスチャンスクールインターナショナル宛 This is to certify _________________________ has my permission to participate in この用紙をもって生徒名は、下記の活動に HS Camp at Tokashiki Island on Wednesday, October 2, to Friday, October 4, 2013. 活動名場所日付参加することを許可します。 I understand that the Okinawa Christian School International’s insurance plan applies to this activity. この活動中の事故は、沖縄クリスチャンスクールインターナショナルの学生保険で保証されるものと了解致します。 Should injuries occur during this activity, I agree to accept the coverage of student insurance as full and 方がー、負傷した場合には、保険会社の同保険に適用する補償額以上のものは、請求致しません。 complete settlement for damages. ______________________________ Signature of Parent or Guardian 父母又は保護者の署名 ___________ Date 日付 Home Phone Number _____________________ Cell Phone Number _____________________ 電話番号携帯電話番号 Transportation: Please fill out. Please check one choice below for Wed., Oct. 3: Please check one choice below for Fri., Oct. 5: ☐ My Child will be at Tomari Port @9:15 am ☐ My Child will be at school by 8:15 am (OCSI bus riders do not need to arrive early) ☐ My child will leave directly from Tomari Port ☐ My child may be dropped off on Rt. 58 ☐ My child must ride back to OCSI For Medical Information please see the back of this form. Okinawa Christian School International 沖縄クリスチャンスクールインターナショナル Medical information. If your student has allergies or medical conditions, please list: What, if any, medications that are need at camp, and when do they need to be taken? Ms. Hadley will dispense any medications that are needed. In the event of a medical emergency, please list the steps or procedures you would like us to take.