Permission Form

 I give my consent for my Child/Trustee, ______________________________to travel with  Jonah A. Maidoff,  Louis Hall, Philippe Jordi and  Janice Perrin  for the purpose of participation in a wilderness experience in Vermont.  Students (Trekkers) are expected to follow all park regulations, rules and laws as well as Charter School principles as defined in the student handbook and as outlined in the pillars of our community.   The trip includes several days on The Long Trail engaged in a rigorous hiking exploration of forest and mountain wilderness.  

I understand that trekking involves some risk.   Reasonable  preparation will be made and precautions taken for a safe and enjoyable adventure.   Should emergency medical attention be required I grant____  (initial),   medics or paramedics to perform treatments or tests as are deemed necessary  in evaluating or treating trauma or illness on my Child/Trustee.

While it is unlikely that such an emergency will present itself, contact numbers are required of parents and guardians.  

It is also understood no medications are to administered without the prior knowledge, parental consent and under the supervision of chaperones.   There is strictly no tobacco, alcohol or other non approved medication to be brought on the trek.  A severe violation of trust may result in a trekkers expulsion from the group and require a parent to retrieve that individual at their own expense.   

Student Signature___________________________________________

Parent/Guardian ___________________________________________

Current Contact information__________________________________
Telephone _____________________________

No electronic music devices, cell phones, ipods or electronic games are to be brought along.  Students may bring cards, notebooks/journals, small musical instruments (packable) and cameras.  The idea behind this is to foster interaction and observation and to reduce the need for external entertainment consumption of commercial products.  Chaperones will have radio communication devices and cell phones for emergency communication.  

Jonah A. Maidoff

A fee of  125.00 covers transportation and basic food supplies.  Any special foods or equipment not owned  by the MVPCS  are the responsibility of the Trekker to supply.