Wild Wintering 2010 Permission Slip

While attending Wild Wintering, which will start at 5:00 p.m. on Sat., Feb. 20th, I agree to the following:

   To treat others with respect
          To clean up after myself
          To respond to reasonable requests from others
          To tell an adult if something needs their attention
          To stick to the bedtime and movie viewing that my family and I agreed for me
          To get up by 8:00am Sunday morning, to have breakfast by 8:45am and to help cleanup.

Youth signature: _____________________________________

I give my permission for my child to attend Wild Wintering, Feb. 20-21st, at Prairie UU Society. This will be an overnight for those who wish to sleep at Prairie. Parents are welcome to stay or leave.
I have read the above guidelines and discussed them with my child(ren).

Parent signature: _____________________________________

I can be reached at ________________________________________________

Emergency contact: ________________________________________________

Doctor (name and number) __________________________________________

Preferred hospital __________________________________________________

Special instructions _________________________________________________________________

Allergies ___________________________________________________

I would like my child to get in his/her sleeping bag, ready to have quiet time at:

_____ 9:00 PM _____ 10:00 PM _____ 12:00 Midnight _____ No bedtime enforced

Dinner: __________(meat) _________ (vegetarian) _________ (vegan) _________ (no preference)

Please have this formed filled out by Sunday, Feb. 7^th. You can hand it in to Rebecca Malke (YREC) or your child's teacher. You can also mail it to:

Prairie UU Society ~ 2010 Whenona Dr. ~ Madison, WI 53711

If you would like to bring a friend, please put her/his name & brief information below. Your friend’s parent will need to fill out a separate permission slip for him/her. If you have questions or need Rebecca to send along another permission slip, please call: 695-3435 or send an e-mail to: youthcoordinator@uuprairie.org

Friend’s name: ___________________ Address: ________________________ Phone: ___________

Parent’s name: ____________________ E-mail: ____________________

Tell us about the movies that we can allow your child to view (exp. G-rated only, G and PG):