People of Peru Project

 *Please read this form. If you are under 18, or are still in high school, have your parent(s) fill it out and have the document notarized.
We/I ____________________grant permission to________________________,  our/my _______________ , to participate in the Peru  Service Project in___________(date: month, year).

We /I understand that should it be necessary for our/my child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs.  Additionally, we/I authorize emergency medical treatment or surgery if necessary. 

Furthermore, we/I authorize our (my) child to ride in any vehicle designated by the adult in whose care our (my) child has been entrusted while on this trip. 

Lastly, we/I agree to accurately complete a medical history form that will be provided in the acceptance letter/packet, realizing that failure to do so, could result in our child's removal from this Service Projects team and loss of any deposits made in their name.

              Participant ___________________________________Date _____________

              Parent/Legal Guardian__________________________Date _____________

              Parent/Legal Guardian__________________________Date _____________  
              Notary Public_________________________________

              State of ____________, in the County of ___________, on___________(date), 

              before me,________________________, Notary Public personally appeared
Name(s) of Signer(s)______________________________________
Name(s) of Signer(s)______________________________________

     Personally known to me_________ OR_________ provided evidence of identity and title and that he/she/them has/have signed this document with the authority of a parent(s) or legal guardian.
Witnessed my hand and official seal.

Signature of Parent or guardian_______________________   _________________________