Aventuras National Zoo 2017 Field Trip Form

Peace Jam Field Trip!

PeaceJam Clubs are youth-led groups that support their community through service. A club can be based in a school, university, or community. Clubs get inspiration from the powerful stories of PeaceJam’s Nobel Laureates, engage in hands-on activities guided by PeaceJam's Youth Guide that explore topics such as finding your purpose, developing your leadership styles, resolving conflict, creating inclusive communities and becoming a global and local agent for change - all while working together on service-learning projects that make a real impact on issues you are passioate about.

Ouray County Peace Jam Lead Coordinator

Sveri May | sverimay@gmail.com | 296-207-1183

Parent's Name*

First NameLast Name

Parent Email*

example@example.com

Parent Phone #*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's Name*

First NameLast Name

Child Birth Date

Date

Child Grade

Child Gender

Which event is your child attending?

Towaoc to the Ute ReservationState Park VolunteeringHoliday Caroling and Senior visitsOther

Permission*

My child has permission to go on this field tripMy child does not have permission to go on this field trip.

Transportation*

My child may ride in the Voyager van (or assigned trip vehicle)I will drive my own child.

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

Please indicate any special instructions your child may need for this trip.

Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.

Field Trip Fee

I agree to pay the overhead cost per student to participate in this filed tripI am seeking financial support for this field trip