Japanese Form B Acknowledgement – Parent/Guardian Permission for Field Trips and Other Activities

2027 Governor's World Language Academy

This form is due no later than [date]. Note: There are [insert number] sections. REMINDER: Please also send a check (NO CASH) for $75 for the student activity fee, payable to Washington and Lee University with the student’s name and designated Academy (Spanish 2027, French 2027, or German 2027, Japanese 2027, Latin 2027) on the memo line mailed to the University at this address: Virginia Governor’s Language Academy Washington and Lee University 204 W Washington St Lexington, VA, 24450

B: Parent/Guardian Permission for Field Trips and Other Activities

Over the course of the Governor’s World Language Academy Program, students will have the opportunity to participate in various field trips and other activities. Some examples of Water-Related Activities are swimming in the pool at the host site for this Academy, or an excursion to a river, lake, or state/national park which may involve lake swimming. Examples of other activities include the use of the sport and/or exercise facilities and equipment at Washington and Lee University, participation in field trips and other program activities accompanied by a staff member, and participation in field trips which will involve charter bus transportation.
I agree to participate in electronic signatures(Required)
Parent/Guardian: Water-Related Activities Swimming in the swimming pool at the host site for this Academy. Excursion to a river, lake, or state/national park which may involve lake swimming.(Required)
(Optional) Parent/Guardian: NOTE: My child is a NON-swimmer
Parent/Guardian: Other Activities Use of the sport and/or exercise facilities and equipment at Washington and Lee University. Participation in field trips and other program activities accompanied by a staff member. Participation in field trips which will involve charter bus transportation.(Required)
I confirm and certify that my child has no medical or health-related condition that would preclude or otherwise render inadvisable his/her participation in any of the activities for which I have granted permission. I understand that participation in these activities carries with it a certain amount of risk that I am willing to accept as a condition of my child’s being allowed to participate in this program. I hereby release and otherwise agree to hold harmless Washington and Lee University and any of its officers or employees from any claims stemming from my child’s participation in this program.(Required)
Parent/Guardian Name(Required)