PARENTAL CONSENT FORM

To be printed & mailed to:

Bill Copeland
2806 N 24th St
Ozark, MO 65721

TO BE COMPLETED BY PARENT OR GUARDIAN OF THE APPLICANT

This is to certify that I am thoroughly familiar with the 
Mammoth Cave Restoration Project at Mammoth Cave National Park 
and that I give my consent for my son/daughter/ward,

________________________________________________________
			(Name)

to participate as a cave cleanup team member. I agree that 
I will not hold the United States Government responsible for 
any non-program accident or illness, and I authorize first-aid, 
or emergency medical care, to be performed at the nearest, 
most adequate facility.

_________________________________    ___________________

Signature of Parent or Guardian      Date



In case of emergency, 

Contact: ____________________________________

Relationship: _______________________________

Phone (Please include area code)

Home: (      ) _________-____________________

Work: (      ) _________-____________________

Address: _______________________________________________

	 _______________________________________________
	
	 _______________________________________________