Service Permission Form

I give permission for my daughter to participate in the following GMAHS activities to:

Sunrise of North Wales, to participate in inter-generational activities between the elderly and the students of GMAHS.
The Casserole Program at GMAHS. Students work with Brock Premier Culinary Services to prepare frozen casserole in Gwynedd’s cafeteria. After the casseroles are frozen, they are delivered to St. John’s Hospice to give to those in need in Philadelphia.
Mercy Neighborhood Ministries in the Germantown area of Philadelphia, to participate in various events for children from Project Mercy. This also includes travel to Merrymead Farms and Mercy Neighborhood Ministries. Project Mercy is an after-school program for children at Mercy Family Center.
Park Clean Up Program in which students travel to different areas of Montgomery County picking up litter to beautify the grounds.
Women of Hope in Philadelphia, to participate in various parties and events. Women of Hope is a home for mentally challenged women ranging from 45 to 80 years old.
Interfaith Hospitality Network of Ambler, an organization that helps families experiencing homelessness and low-income families achieve sustainable independence through a community-based response.

Daughter's first Namerequired

Last Namerequired

Please list the names of parent/guardian and/or persons to be contacted in the event of an emergency and the telephone numbers where they can be reached during the hours of the service events or programs.

Primary Contact Namerequired

Cell Phonerequired

Secondary Contact

Cell Phone

In the event of a serious injury/accident, I give permission for my daughter to be taken to the nearest physician or hospital to be treated.

I agree*

Insurance Plan

Policy Number

Is your daughter allergic to any foods and/or medications?*

Yes No

Please describe:required

Is your daughter currently on any medications?*

Yes No

Please Name:required

Please answer yes or no to the following permissions.

Permission to ride in a car or van or bus driven by a faculty member, staff member, parent or other adult supervisor

Yes No

Permission to ride in a car driven by a responsible student to and from these programs

Yes No

Permission to drive herself and other students to and from the above programs

Yes No

Please send a confirmation email to the address below*: