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2. 
4. Field Trip Release
6. During the week long LEAP, your child will have the opportunity to visit the Betty Queen Intergenerational Center and the Louisa County Pool.
8. Please complete the section below authorizing your child to participate in these trips.
10. I,
11. Full Name*
12. , hereby authorize my
14. Son or Daughter*
    -- Select One --SonDaughter
15. Son or Daughter's Name*
17. to attend the field trip(s) listed above.
19. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
21. Electronic Signature*
22. Date*
    Date

    Date
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field