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History Encounters – LaCanada Elementary

February 6-10, 2023

"*" indicates required fields

1Participant
2Medical
3Lunch
4Agreement

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Participant Information

Select an Option from below*
Name*
MM slash DD slash YYYY
Gender*
Home Address*

Parents/Emergency Contacts

You must add at least one emergency contact for the applicant.
Related Contact Name
Is Emergency Contact?
Add another Contact
Related Contact Name
Is Emergency Contact?

Participant Medical Information

Doctor's Information

Insurance Information

MM slash DD slash YYYY
Dietary Limitations*

Choose a Philly Style Lunch*
Release and Permission Agreement*
1. The undersigned is a parent or legal guardian legally authorized to enter into this agreement on behalf of the minor named above.
2. Release and hold harmless the FFVF from any and all claims, damages, or losses of any kind, including any attorney fees, in connection with the busing service provided by the FFVF.
3. That the FFVF is not responsible for any personal belongings or items brought to FFVF, including all activities related there to, by the minor named above which may be lost broken missing or stolen.
4. I am fully aware of the risks inherent in various program activities, and agree to hold harmless and will not hold the FFVF its instructors, employees, associates, affiliates, or any other entity or person associated with the FFVF liable for any injury or loss that will/ may occur during any FFVF program.
5. I give my permission for the minor child named above to participate in field trips, and overnight activities, utilizing bus transportation provided by the FFVF.
6. I give permission for the FFVF to use pictures of the minor named above in any advertising promotional material.
7. The FFVF, its instructors, employees, associates, agents, servants, affiliates, or any other entity or person associated with the FFVF is permitted to secure emergency medical/surgical treatment for the minor child named above that may be deemed necessary under circumstances.
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Does not include air transportation
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Freedoms Foundation of Valley Forge
  • P.O. Box 67
    Valley Forge, PA 19481
  • 1601 Valley Forge Road
    Phoenixville, PA 19460
  • 610.933.8825
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