Fire Tribe Hawaii

Autumn Equinox Fire Circle
Leeward Oahu, Hawaii
September 16th - 18th, 2011

Minor's Release Form

In the cases where minor children will attend the Gathering with an adult other than a parent or legal guardian, the parent must complete this form granting permission for their child to attend with the designated supervising adult. The parent must also complete the waiver form for the child.

I, _______________________ (parent's name), as the parent or legal guardian of ____________________ (child's name), hereby grant permission to _____________________________ (supervising adult) to take my child to Fire Tribe Hawaii's Winter Solstice Gathering December 13-18, 2011 . The supervising adult is given full responsibility for my child while at the Gathering and has my permission to obtain any necessary medical treatment in the event of an emergency.

By signing this Release we also indicate that we have both read, understood and agree to the following:

The Supervising Adult named above is responsible for ensuring that my child is safe, is behaving appropriately for the Gathering, and has adult supervision. Adults and children who do not follow through with these requirements will be asked to leave the Gathering, with no refund.

The Supervising Adult must bring this form (Minor's Release Form) to the Gathering, signed by the child's parent or legal guardian. All minors must be pre-registered, and minors arriving on site without pre-registration, the Minor's Release Form, and a Waiver Form for the child will be turned away with no refund to the accompanying adult.

Emergency Contact Information:

Parent's Name ______________________________________________
Phone ___________________ Alt Phone ___________________
Address ______________________________________________
Minor's Name __________________________________
Minor's Social Security Number _____________________
Insurance Company or Group ____________________
Policy Number _____________
Printed Name of parent/legal guardian _______________________
Signature of parent/legal guardian _______________________ Date _________
Printed Name of Supervising Adult __________________
Signature of Supervising Adult _______________________ Date _________

This form must accompany your child to the Gathering.