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The Junior State 800 S. Claremont St, Suite 202, San Mateo, CA 94402 PARENTAL PERMISSION FORM

CALL (800) 334-5353 TO OBTAIN A CONVENTION BROCHURE or VISIT WWW.JSA.ORG FOR MORE INFORMATION.

Parents: Please read this information carefully and review it with your child before signing. Your child should have a very exciting educational experience at the upcoming Junior State event. He or she will have an opportunity to debate current issues. We hope you have read the convention brochure, which lists the topics to be discussed. In advance of the event, your child should do some special reading to prepare for these debates and other educational activities.

Please review the convention rules with your son or daughter. By sending your child to the convention, you agree to pick him or her up at your own expense if these rules are violated. Rule violators are sent home and are reported to their schools for appropriate disciplinary action. If you have any questions about the rules, travel arrangements, or the educational program, please call The Junior State office at 800/334-5353.

CONVENTION RULES 1. All rules for school field trips prevail. Use of illegal drugs or alcohol is not permitted. Students also will be punished if they are in a room where drugs or alcohol are present. The use of tobacco products is not allowed. To ensure these rules are obeyed, the Teacher/advisor and The Junior Statesmen Foundation must approve the attendance of each delegate. We reserve the right to deny any student the privilege of attending the event.

2. At 8 p.m., students will meet with their Teachers/advisors for roll call and may not leave the hotel thereafter. At curfew, Teachers/advisorss will check delegates at their rooms. Delegates must remain quietly in their own rooms after curfew. Pizza deliveries and room service deliveries are not permitted after curfew. Delegates also are required to meet with the Teachers/advisors at other designated times.

  • 3.

    Delegates must attend all conference activities.

  • 4.

    At no time may young men and women be in each others' rooms.

  • 5.

    Delegates may not leave the convention hotel without the permission of their Teachers/advisors. During meal times, with their Teachers/advisors's

permission, delegates may leave the hotel to eat in designated areas. Under no circumstances are delegates to leave the hotel after 8:00 p.m.

  • 6.

    Delegates must wear their name tags above the waist in a visible location at all times.

  • 7.

    All students assigned to a room are responsible for any charges made to the room. All students assigned to a room are also responsible for the condition of

the room. No outside phone calls can be made from student hotel rooms. Room service and other items may not be charged to a students room. No delegate may change rooms without the permission of a Junior Statesmen staff member at the event. The hotel staff will house four students in each room with two large double beds.

  • 8.

    No student may drive a car to the convention or ride in a student driven car during the convention.

  • 9.

    Visitors are not allowed in the convention hotel. Delegates are not allowed to associate with any visitor who is not an official guest of the Junior Statesmen

program.

10. Students must always conduct themselves according to the highest standards of behavior. They must be considerate of and respect the rights of other delegates, staff, teachers/advisorss, and other hotel guests. Students may not open, throw anything out of, or shout out of windows. Students must stay off balconies, roofs, and out of all restricted areas. All public laws must be complied with. Reasonable and due care shall be exercised by all students to ensure safety, good order, and to preserve the good reputations of their respective schools and the Junior State of America.

11. Students should not bring expensive items to the convention. Valuable items must be stored in the hotel safe or with the bellmen. The Junior State/The Junior Statesmen Foundation are not responsible for items stored in a luggage storage area. Use of radios or portable stereos is permitted only with headphones.

  • 12.

    Delegates that voluntarily withdraw from the convention, or that are sent home for conduct problems, will not receive refunds.

  • 13.

    Delegates and their parents agree that The Junior State may use any photographs taken during the convention for promotional purposes.

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  • ---

    I agree to abide by all of the Junior State convention rules under the terms described on this permission form. I understand that in

the event of a serious violation of the rules, my parents and my school will be notified, and I may be sent home at my own expense without a refund.

X___________________________________________________________________________________________________________________________

Student Signature

Print Name

Date

I agree to the terms described on this permission slip and give my child permission to attend the upcoming Junior State convention under those terms.

The Junior Statesmen Foundation has my permission to obtain emergency medical treatment for my child at my expense.

X___________________________________________________________________________________________________________________________

Signature of Parent or Guardian

Print Name

Date

STUDENT NAME

STUDENT EMAIL

______________________________

___________________________

HIGH SCHOOL

YEAR OF GRADUATION

SEX: MALE

FEMALE

ADDRESS

________________________

CITY

_______________

STATE

____ ZIP

____ HOME

_______________________________________________

_________________

____________

_______

TELEPHONE

CELL PHONE

_______________________

____________________________

IN CASE OF EMERGENCY

________________________________________________________________________

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