Mountainair at the Belen Pool

Will you or your children be needing to ride the bus to the Belen Pool on Saturday, June 22nd?

YesNo

If you live within the Mountainair School District, you can attend this event!

You MUST sign up in order to attend!

If you plan to meet us at the pool, you HAVE to meet us by 12:15 p.m. Belen has a capacity limit and is first come, first serve. If you aren't there when we go in, then unfortunately you can't enter with the group and would have to pay yourself. Be there by 1:15 p.m. Bus is meeting at the Mountainair High School parking lot.

Parent / Guardian Name *

First NameLast Name

Phone Number*

Please enter a valid phone number.

# of People in Your Group? *

Mountainair Youth Summer Program
Belen Pool Trip Permission Slip

Date of Event: Saturday, June 22nd 1:30 p.m. to 3:30 p.m.
Location: Belen Swimming Pool located on the Belen High School Campus on 1619 West Delgado right before the football field.
Bus Meet Time: 12:00 p.m. at Mountainair High School parking lot. Bus is leaving at 12:15 p.m. sharp.
Non-Bus Meet Time: Belen Pool at 1:15 p.m.
Arrival Time Back: Approximately 5:30 p.m.
Cost: Entrance Fee to pool is covered for all Mountainair School District residents. Travel on the bus is limited on a first-come/first serve basis until bus is full. If you choose to travel on your own to the pool, you just show up at the Belen Swimming Pool by 1:15 p.m.

It is understood that all reasonable caution will be taken by those persons in charge to prevent injuries, however, neither those
in charge nor the school district, nor the Town of Mountainair, nor the City of Belen, nor Valencia County, nor Belen Schools, nor Torrance County, nor MONTA,
nor any sponsor or anyone involved with this trip or the health department shall be held responsible in case of an accident.

If a child does not follow the behavior rules set by the Mountainair Public Schools, the parent or guardian will be called to come and pick up their child from the pool in Belen and may not be able to attend further programs this
summer. Children not enrolled in Mountainair Public Schools (such as toddlers) MUST be accompanied by a parent/guardian on the bus.

Please enter the names of the people in your group that are going. By entering their name below, you agree you are a parent or guardian with permission to sign on their behalf. Please separate names using a comma. If you will be riding the bus as well, please include your name. If you are going to be a chaperone only, please enter your name below and put "Chaperone" next to it. By entering their name below, you agree to the above terms listed in the permission slip section.

Example: John Doe, Joan Doe, Joseph Doe

Emergency Contact Name

First NameLast Name

Emergency Phone Number

Please enter a valid phone number.

If an injury does occur, what is your hospital preference?

By signing below, you agree to the permission slip portion of this form. A physical permission slip will NOT be required. Please make sure all phone numbers are correct and that someone will answer them in case of an emergency. You also agree that you are the parent/guardian of children listed above and that you have the right to give permission via this online form/permission slip.

If you complete this form and then find out you are unable to make it, please send an email to mountainairmayor@gmail.com or let Town Hall know so we can remove you from the list. This is to help us keep track of who's going on the bus so we can allow all that can fit. Town Hall can be contacted by calling 505-847-2321.

Mountainair at the Belen Pool

Permission Slip Section