Girls Group U-Pick Fruit

BOYS & GIRLS CLUBS OF SOUTHWEST WASHINGTON

Field Trip Permission Form:

BOYS & GIRLS CLUBS
OF SOUTHWEST WASHINGTON

Girls Group: U-Pick Fruit @ Columbia Farms

Date: 7/22/2026

Time 12pm-2pm

Location: 21024 NW Gillihan Rd, Portland, OR 97231

Cost: Free!

Transportation: Outreach will provide transportion

Notes: Girls Group is going to U-Pick for a fun day out in the sun. The girks will have an opportunity to pick fruit and take it home with them.

Please return this permission slip by:
7/21/2026

I give permission for my child

on

7/22/2026 12pm-2pm to attend the field trip at Girls Group: U-Pick Fruit @ Columbia Farms

As the parent/guardian of the above name, I hereby release, absolve, indemnify, and agree to hold harmless the Boys & Girls Club of Southwest Washington, the organizers, sponsors, supervisors, participants, and persons transporting my child to and from activities from any claim arising out of injury to my child, whether it is the result of negligence or any other cause. I hereby give consent for my child to be given a physical exam or emergency treatment by medical personnel in the event of injury or illness to include transportation to and from care. In case of such an emergency, please contact: (see below)

Isaac (TTC): 360-907-0904, Daniel (Heights): 564-241-0329, Zoie (Evergreen): 564-241-0332

Parent/Guardian Name

Parent Phone Number

Format: (000) 000-0000.

Emergency Contact (other than Parent/Guardian listed above)

Emergency Contact Phone

Format: (000) 000-0000.

Parent/Guardian Signature

Date