Parent/Guardian Permission Form

Parent/Guardian names & phone numbers in case of emergency:

__________________________________________________(_____)________________________

Name (Please Print)                                                                    Phone #

__________________________________________________(_____)________________________

Name (Please Print)                                                                    Phone #

Name of person to contact in case of emergency if parent/guardian cannot be reached:

__________________________________________________________________(_____)____________
Name (Please Print)                            Address                 City              State                Phone#

Relationship to First Bytes 2008 Participant:                                                             

Please indicate your permission by initialing the appropriate statements and signing this form.

As a part of the First Bytes curriculum, we have scheduled off-campus trips to industry sites and non-academic activities, such as sightseeing.  Staff members of the First Bytes Program will accompany the students at all times during scheduled activities.  Your permission is needed in order for your daughter/ward to participate in off-campus First Bytes activities.

____   My daughter/ward has my permission to participate in the First Bytes off-campus activities.

____   I accept responsibility for any damages to property for which my daughter/ward is responsible.  Your daughter/ward was selected from over 200 applicants to participate in First Bytes 2008.  If at any time it becomes apparent that your daughter/ward will not be able to attend First Bytes, it is absolutely essential that you contact the First Bytes office immediately to notify us of your daughter/ward’s cancellation.  There are numerous alternates who are anxiously awaiting the announcement of an available spot.  We will fill all spots before the start of First Bytes 2008.  However, we cannot do so without your cooperation.

____   I will notify the First Bytes Program immediately if my daughter/ward is unable to attend First Bytes 2008.

____   I grant permission to the Department of Computer Sciences to use pictures, videos, or any other likeness of my daughter/ward taken at First Bytes for publicity purposes (i.e. brochures, website, etc.)

____   My daughter/ward has my permission to watch a PG13 rated movie.

____   I understand that a $100 deposit check made payable to the University of Texas at Austin will be fully refunded when my daughter/ward registers at camp on July 20th.  (Waivers of the deposit fee may be available.  Please contact us.)

I have read all of the above and agree to/grant my permission as indicated by my signature below.

________________________________________________________________________________             Parent/Guardian Signature                                                                Date

            

All required forms and a $100 deposit check must be received in the Department of Computer Sciences office by Tuesday, July 1, 2008, or an Alternate will be chosen to replace your daughter/ward.  If you have any questions, please call the First Bytes office.                                

First Bytes
Department of Computer Sciences
The University of Texas at Austin
1 University Station, C0500
Austin, Texas 78712-0233
(512) 471-9587
firstbytes@cs.utexas.edu