TO: The GREAT PLAINS MATH LEAGUE/ARML TEAMS FROM MISSOURI AND/OR KANSAS ("Team") and AUTHORIZED CHAPERONES ("Chaperones"):

As the parent or guardian of _____________________________ ("Student"), I give permission for Student to participate in the ARML contest in Iowa City and related travel on May 31 through June 2, 2001. I understand that travel will be by vehicles driven by team coaches or parents, and Student is hereby given permission to ride in any vehicle driven by a team coach or parent. I agree not to hold the Team or any of its agents responsible for accidents or injuries to Student other than those specifically caused by willful individual negligence, in which case liability shall be limited to the responsible individual or individuals. It is understood that Student is to make every effort to behave responsibly on the trip, including adhering to schedules and curfews established by the Chaperones. Furthermore, it is understood that this trip is not an officially-sponsored trip of the school that Student attends or any other school unless the school has specifically designated the trip as such. In case of a medical emergency concerning Student at a time when I cannot be notified, I authorize Team representatives with custody of this Authorization to consent to any necessary medical care or treatment, including hospitalization. The Chaperones shall have the following powers: The power to seek appropriate medical treatment or attention on behalf of Student as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits; The power to authorize medical treatment or medical procedures in an emergency situation; The power to make appropriate decisions regarding clothing, bodily nourishment, and shelter.

Signature: ______________________________Date: ____________________

Print Name: ______________________________

Telephone numbers where Parent/Guardian may be reached during the trip:
Home: _________________ Work: _________________ Other: _________________

Student's doctor: Name: ______________________________ Phone Number: ____________________

Name of Parent/Guardian's Insurance: ________________________________________

Insurance Policy No. or Group No.: ________________________________________

Please list any medications, allergies, or other relevant medical information pertaining to Student on the back of this sheet.