PAUL PCS DRAGONBOAT Permission Slip

We will be practicing from time to time this summer and we are scheduled to start on Wednesday July 1st at 3:30pm
at Paul. We will then have more plans to actually go to the water at Gangplank Marina. If you have any questions.
Please call Mr. Magnuson at 202-368-4883

I _________________________________, give permission for ____________________

(Your name) (Your son or daughter)
to participate in the Dragon Boat team at PAUL PCS.

I understand that the nature of a Dragon Boat race is a physical activity and I have determined that my son/daughter
is in adequate physical condition to participate in such a rowing activity. (Your initials) __________

Does your son/daughter have health insurance? ___________________

Health Insurance Company ____________________________________ Policy # ______________________

I understand that Mr. Magnuson, Mr. Bordenkecher or Paul Public Charter School are not responsible for any injury
sustained by my son or daughter during a practice or the actual race. (Your initials) ________________

In case of an injury I give Mr. Magnuson or Mr. Bordenkecher permission to act on my behalf, including ambulance
service if necessary. (Your initials) ________

I also give permission for Paul PCS to use images and or video from the Dragon Boat team on our school’s website
or in other promotional materials. (Your Initials) __________________________

Signature:______________________________________ Date:_________________

Emergency Contact Information & Phone #s

Name_______________________________________ Phone __________________________________

Name_______________________________________ Phone __________________________________
Name_______________________________________ Phone __________________________________
Name_______________________________________ Phone __________________________________