Vancouver Branch NAACP

1
Vancouver Branch NAACP Washington State Dept of
Transportation State Road 500 Clean Up Ages 16
Older September 26 2009 800 A.M. 12 Noon
Arrive 800 A.M. Forest Service HQ. 10600 N.E.
51st Circle Vancouver, WA 98682
Pick up State Road 500 (Andresen to Gher RD)
National Public Lands Day is the nations largest
hands-on volunteer effort to improve and enhance
the public lands Americans enjoy. This year
Vancouver Branch NAACP Youth Group has adopted
SR-500 between Andresen and Gher Road as a weed
and trash removal site. Lunch will be provided
in the Gifford Pinchot National Forest Parking
Lot at 1200 Noon.
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Event Information
Date September 26, 2009 Time
800 a.m. 12 noon Place Gifford
Pinchot NF Forest Headquarters
State Road 500 Clean Up Day

• --Registration and check-in will begin at 800
  A.M. at Gifford Pinchot National Forest
  headquarters.
• --Departure from GPNF Forest headquarters 10600
  NE 51st Circle Vancouver WA
• PLEASE READ
• The following necessities to be brought by each
  child
• Long Sleeve shirt, jacket, long pants, extra
  pair of socks, sturdy shoes-no sandals or open
  toed shoes.
• If your son/daughter have special needs please
  make accommodations for this event so that all
  involved are aware, or keep your child at home.
• Please inform us of your Childs needs before
  departing for home.
• Parent or Guardian should keep the top half of
  this form.

Permission Slip
I give my son/daughter, __________________________
, permission participate in the Muddy River
Restoration Camp out. He/she is in good physical
condition and has not had any serious illness or
operation since her last health examination.
He/she has my permission to receive first aid or
to receive emergency treatment from qualified
Camp Personnel or a licensed physician. It is
understood that all reasonable efforts would be
made to contact the parent or guardian. All
partners will not be held liable. Any fees
associated with emergency treatment will be the
responsibility of the parent or
guardian. Special Needs (Medical/Food Allergies
etc)_____________________________________________
________ Check if child MAY NOT ___ Be
photographed for publicity purposes ___
Participate in __________________ (e.g. active
sport) _____________________________
____________________ (Parent or Guardian
Signature) Date Print
Name _____________________________
Alternate if Parent/Guardian cannot be
reached Address _____________________________
Name________________________________ ______
_______________________ Relationship______
_____________________ Phone ___________________
__________ Phone__________________________
______