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There are no islands in the world today, and there are no domestic and internationaldiseases. We live in a global village. We live in a shrinking world. And there are manycontacts between us. No one is isolated, no one can be smug and sit in his or her corner andsay, 'I'm safe because it is somewhere else."

-Kofi Annan

www.boisdale.co.uk

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Fast for Awa reness Voluntary Activity Permission Form

I hereby give permission for my child, ____________________, to participate in the Fast for Awarenessevent at Gunn High School from Friday, May 27, 2011 to Saturday, May 28, 2011. I understand thatparticipation in this voluntary event means that my child will only drink water and juice for the 30-hourduration and may participate in physical activities during the event.

In the event of illness or injury, I authorize the activity supervisor to consent to whatever emergencymedical, surgical or dental care is considered necessary in the best judgment of the attending physician,surgeon, or dentist. I agree to pay for such medical care and understand that an attempt will be made tocontact me, before such care is administered.

I hereby hold harmless and waive all claims and liability against the Palo Alto Unified School District, KeyClub and its officers, agents, employees and volunteers for injury accident occurring by reason ofparticipation in the activity.

I have read, understood, and agree to all of the provisions stated above. I give my permission for my child toparticipate in this voluntary activity.Name of parent/ guardian ___________________________________ Date_______________

Signature of parent/ guardian ____________________________________

Students name ___________________________________

Signature of student________________________________

Students Email Address _____________________________

Emergency contact (if different from above) __________________________________

My child will attend the Fast for Awareness (check one): for the full duration, from 6 p.m. on Friday, May 27, 2011 to Saturday, May 28, 2011. My child does not

have permission to leave school grounds during this time.

for the following times (please specify times and date):_________________________________________________________________________________.My child has permission to leave school grounds at the specified times.

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In order to provide a safe experience for all Fast for Awareness participants, there will be one adultchaperone (teacher, parent, or other adult volunteer) for every 25 students. We are still looking forchaperones; please help chaperone if you are available on May 27-28.

I can chaperone for the Fast for Awareness event. My contact number is: ___________________.

I cannot chaperone for Fast for Awareness event.

My child has the following medical needs (please explain):

_______________________________________________________________________________________

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Fast for Awareness Code of Conduc t

Key Club members, adult supervisors and participants are expected to demonstrate behavior consistent withthe high ideals of Key Club and should abide by the provisions of this Code while in attendance at the Fastfor Awareness. Every participant will respect the authority of the chaperones and Key Club Board.

Responsible Behavior1. All participants are expected to abide by all school rules and regulations.2. Participants must respect the personal property of others as well as the property of the facility. Any

damage caused by a participant must be paid for by that participant.3. Participants are expected not to take any action that creates unnecessary physical or mental

discomfort, harassment or ridicule of others.4. Participants may not anything of a dangerous nature or act that would threaten the safety and well-

being of others.5. All participants must wear ID wristbands at all times during the event.

Lodging1. Participants staying in the gym must sleep in the designated area.2. All participants are expected to abide by the curfew specified by the Key Club Board and schedule.3. All participants may not leave the premises at any time during the event, with the exception of

written parental consent for the attendee.4. Items within this section may be modified by the Key Club Board and chaperones if deemed

necessary.

Enforcement1. Violations of this Code will result in notification to the respective Key Club Board Member and

chaperone.2. Violations involving destruction of property, possession, consumption or use of alcoholic beverages

or controlled substance will result in dismissal of the attendee from the event.3. Violations involving improper and/or unsafe behavior, failure to cooperate with the Key Club Board

and/or chaperones will not be tolerated and will lead to the dismissal of the attendee from the event.4. Any Key Club Board Member and chaperone has the discretion to dismiss any participant with due

reason. Participants who have been dismissed will not be granted community service hours.5. Notification, in writing, will be made by the Key Club Board Member, Kiwanis sponsor or chaperone

to the parents/guardian of any participant disciplined under this section.6. These rules are effective as of the time the participant arrives at this event, until the time departed.

I have read, understood, and agree to all of the provisions stated above.Participant Name:__________________________ Parent/guardian Name: ________________________

(print) (print)

Participant Signature: ______________________ Parent/guardian signature: _____________________

An adult chaperone for Key Club shall be a Kiwanis member, faculty member, parent, legal

guardian, or person who is: in loco parentis;over the age of twenty-one (21); approved by the school;registered with the Key Club at Fast For Awareness. The adult chaperone shall be responsible forthe participants assigned to him/her.

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Fast for Awareness Sponsor Record SheetAfter receiving a donation (make sure all checks are made payable to Action Against Hunger--USA), fill out thesponsor records below to keep track of the people who have given and their amounts. After the Fast is over,remove these sponsor records and make a copy for thank-you letters. Then place these records in the collectionenvelope in the back of this booklet, and hand it over to your group leader.

# NameMr./Mrs./Miss/Other, First,Last

Address Phone Number E-mail Address Gift AmountCash? /Check?

1

2

3

4

5

6

7

89

10

11

12

13

14

15

16

17

18

91 cents of every dollar donated goes directly to field programs. Your gift saves lives in many ways$35 provides a hand pump for drinking water in Cambodia$50 provides high-energy milk and porridge for a malnourished child for 30 days$100 helps A.A.H supply seeds and farming equipment to a family displaced by civil war in Congo$250 provides fluids for 25 children suffering from cholera in Congo

Donations to Action Against HungerUSA are tax deductible. So please give a receipt to anyone who donates $250or more, or upon request. Present your sponsor with a receipt when collecting their donations. You can also remindyour sponsor that a canceled check serves as proof of donations under $250. If you need additional receipts, ask yourgroup leader for them.

Fast For Awareness

Gift Receipt

_________________Sponsor Name

Fast For Awareness

Gift Receipt

_________________Sponsor Name

Fast For Awareness

Gift Receipt

_________________Sponsor Name

Fast For Awareness

Gift Receipt

_________________Sponsor Name

Fast For Awareness

Gift Receipt

_________________Sponsor Name

$_________________Total Gift Amount

$_________________Total Gift Amount

$_________________Total Gift Amount

$_________________Total Gift Amount

$_________________Total Gift Amount

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Our Sponsors