the largest remaining low-elevation old-growth

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1 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org Dear Teacher/Trip Organizer, Every spring and fall, Jawbone Flats comes alive with students exploring, discovering, and uncovering the world around them. Our classroom – the largest remaining low-elevation old-growth forest in the Pacific Northwest - is a rainforest wilderness protected from ridgeline to ridgeline. Our programs bring students into contact with an astonishing diversity of plants, fungi, lichen, macro- invertebrates, amphibians and more as they study every aspect of forest ecology and root themselves into their place in the world as lifelong learners. We hope you will most everything you need to know about planning your trip to Jawbone Flats in this packet. We understand that your role in organizing this trip is crucial and we thank you for choosing Opal Creek as your Outdoor School destination. Our on-site Program Manager, Kelsey Madison, is available to answer any questions primarily by email, but can coordinate a phone call if necessary. Below you will find important contact information numbers. Here at Opal Creek, we believe that people of all ages benefit from hands-on learning experiences. We hike every day, rain or shine, so all students and adults should be mentally and physically prepared and arrive with the proper attitude and equipment. The following guidelines and information are provided to help you prepare for the program so that everyone has a great time. We look forward to seeing you in the woods! The 2020 Opal Creek Outdoor School Team

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Dear Teacher/Trip Organizer,
Every spring and fall, Jawbone Flats comes alive with students exploring, discovering, and
uncovering the world around them. Our classroom – the largest remaining low-elevation old-growth
forest in the Pacific Northwest - is a rainforest wilderness protected from ridgeline to ridgeline. Our
programs bring students into contact with an astonishing diversity of plants, fungi, lichen, macro-
invertebrates, amphibians and more as they study every aspect of forest ecology and root
themselves into their place in the world as lifelong learners.
We hope you will most everything you need to know about planning your trip to Jawbone Flats in
this packet. We understand that your role in organizing this trip is crucial and we thank you for
choosing Opal Creek as your Outdoor School destination. Our on-site Program Manager, Kelsey
Madison, is available to answer any questions primarily by email, but can coordinate a phone call if
necessary. Below you will find important contact information numbers.
Here at Opal Creek, we believe that people of all ages benefit from hands-on learning experiences.
We hike every day, rain or shine, so all students and adults should be mentally and physically
prepared and arrive with the proper attitude and equipment. The following guidelines and
information are provided to help you prepare for the program so that everyone has a great time.
We look forward to seeing you in the woods!
The 2020 Opal Creek Outdoor School Team
2 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Trip Organizer Task List …………..………... 3
Curriculum Options …………………………... 4-6
Jawbone Flats Information ………………... 9-11
Curriculum, student numbers, student medical information and food allergies.
Megan Selvig, Program Director: (503) 892-2782 or [email protected]
New schools in-school meeting/presentation, available for questions and last
minute changes to your trip via phone or email.
Kristen Klever, Office Manager: (503) 892-2782 or [email protected]
Trip scheduling, billing, reservation contracts.
Digital pdfs and additional information available at
Trip Organizer Task List:
As Soon As Possible!
Schedule an in-school meeting with our Program Director if you are a first-time visitor.
Select chaperones: please bring a minimum of one adult to ten students and no more than one adult
to five students. All school teachers should be included in this adult count. Consider gender
breakdown of chaperones in relation to the number of building you will be housed in.
Arrange appropriate bus or other transportation. Keep in mind that all programs begin and end at
noon at the Opal Creek trailhead.
Share the Rules & Expectations page with students.
Send Chaperone Pre-Trip Packet link to all chaperones (https://www.opalcreek.org/for-chaperones/) or print, photocopy and distribute information by hand.
Send family pre-trip information link to all parents/guardians (https://www.opalcreek.org/for- families/) or print, photocopy and distribute information by hand.
Collect completed registration forms from all adult and student participants. These must be brought
with you to Jawbone Flats.
One Month Prior to Your Trip
Inform the Program Manager of your final group numbers. You will be billed for the number reported
30 days out, with a 10% reduction allowed for illness. See your reservation contract for more
information.
Email any food allergy or special dietary needs AND the severity of the allergy or restriction to the
Program Manager. Our staff MUST have at least 30 days’ notice of any special food requirements.
Fill out the Google Form to help us get to know your group better:
https://forms.gle/xMtTNkUaWW3emmpv9
Email your curriculum choices to the Program Manager for a draft itinerary.
Communicate with the Program Manager about lodging and logistics. Your lodging information will
not be given to you without a 30-day out number of students and chaperones.
We recommend conducting an orientation and logistics meeting for all chaperones. Discuss
assignments, activity time periods, evening programs and dining hall and dorm supervision.
Two Weeks Prior to Your Trip
Let the Program Manager know of any changes in numbers of students, medical, or dietary needs.
Divide students into hiking/learning groups. The general ratio is 15 students to 1 group.
Assign cabins/rooms for students and chaperones with lodging information from Program Manager.
Trip Day Check-off List
All students and chaperones have a lunch for the first day.
All students have turned in a registration form and waiver.
All chaperones/teachers have completed a registration form and waiver.
All Students and Chaperones have appropriate clothing and footwear for current weather conditions
(often cold and wet).
Bring registration forms and waivers with you to Opal Creek.
Curriculum Options
Opal Creek Ancient Forest Center will work with you to customize your program curriculum and
itinerary to fit your educational goals and needs. All students who visit Opal Creek begin their trip
with a three-mile walk through the old-growth forest to reach Jawbone Flats. Our instructors lead
this hike, and the education begins immediately. Our curriculum is concept-based, hands-on, and
experiential. The students will be outdoors, exploring nature through hands-on activities, learning
science by doing science.
Please review the curriculum options below and let the Program Manager know what you would like
to focus on during your stay. They will then create a schedule based on your interests and what they
think will work best for your group size, average age and time of year. Once you are sent a draft
schedule please review it and let them know if you have questions or would like to make any
changes. Please note that the schedule is a guideline for your stay and can be changed as you and
the Opal Creek instructors deem necessary (due to weather, energy levels, etc.) once you are on
site.
ONE NIGHT: If staying for one night, you should select one interest group and one evening program.
TWO OR MORE NIGHTS: please choose one field study and two interests group OR an extended field
study and one interest group for each full day you are in Jawbone Flats and one evening program for
each night.
FIELD STUDIES:
Field studies are typically a 2-hour in-depth study of a specific subject area. Possible topics include:
Forest Ecology: Students compare old growth and second growth forest plots using tools
(clinometer, DBH tape measure, densiometer, field guides, etc.) to invoke a discussion of
biodiversity, ancient forest habitat, and forest succession. Other activities could include
nurse log surveys, field journaling, or meter plots.
Stream Ecology: A closer look at the streams of the ancient forest. An exploration of water
quality indicators, which includes macroinvertebrate and amphibian surveys of local creeks,
and can include the use of water quality probes (pH, DO2, temperature, conductivity, etc.).
Geology/Local History: A hike to Ruth Mine with a lesson on the formation of the Western
Cascades and the rocks and minerals found here, including a discussion of the history of
mining in the area. We recommend pairing the Mineralogy interest group with this field
study.
EXTENDED FIELD STUDY:
An extended field study is a 4-5 hour excursion covering several subject areas. With a full
day on the trail, breadth and depth of study is flexible according to the interests/abilities of
each group. Topics could include cultural history, forest ecology, botany, geologic history,
and more.
INTEREST GROUPS:
Typically interest groups are shorter studies of 1 hour. Interest groups are conducted in close
proximity to Jawbone Flats. Possible topics include:
Owl Pellets: A discussion of owl species found at Opal Creek, their adaptations, and
how/why they produce pellets. Students then dissect owl pellets, distinguishing and re-
articulating the skeletons of the small mammals found inside.
Meter Plots: Students take a close look at shrub and ground cover diversity within a square
meter area, helping them to see beyond the trees when looking at the forest.
Mosses and Lichens: Collection, identification and discussion of the role these organisms
play in the ancient forest.
Macroinvertebrates: Collection and identification of the macroinvertebrates living in Opal
Creek or the Little North Fork of the Santiam paired with a discussion of macroinvertebrates
as indicators of water quality.
Fluvial Geomorphology/Watersheds: Learn about the processes through which water carves
the earth surface and the resulting channel shapes through exploration of stream table.
Build model watersheds to better understand water flow, pollution, and the importance of an
uncut watershed like Opal Creek.
Ethnobotany: An inside hands-on lesson to learn about native plants and animals in a
Kalapuya/Molalla-style seasonal round. Each student will use field guides to research a
native plant and connect it with a traditional use.
Mineralogy: Students explore geology through an investigation into the rocks and minerals
found at Opal Creek and learn how to identify them.
Team Building: Students work as a group to solve a variety of mental and physical
challenges through team-building activities.
Amphibians (SPRING): Spring is the ideal season to collect and identify some of the many
amphibians that live in the Opal Creek Wilderness. Amphibian life cycles and their role as
indicator species are also discussed.
Fungi/Mushrooms (FALL): This fall program focuses on the basic of fungi at Opal Creek and
their ecology. After learning about the structure and types of fungi, students will delve
deeper in examining and collecting local species. Fungus is a seasonal interest group,
suggested for late September-November.
EVENING PROGRAMS:
Evening programs are 1-1.5 hours and take place after students have dinner and do chores. Note:
many evening programs are also adaptable to a 1-hour interest group session. Possible activities
include:
Evening in the Ancient Forest: A slideshow that covers the sounds and adaptations of
nocturnal animals in the Opal Creek Wilderness, followed by a short sensory hike to fully
experience evening in the ancient forest. This is a great first night activity.
Animal Adaptations Auction: A creative exploration of different adaptations of animals found
at Opal Creek in an auction format where students bid for adaptations to create their own
creature.
Botany Study through Art: Explore the plants of the ancient forest in more detail by using a
variety of media. Emphasis is on plant structure and plant ID, with a creative twist. Ideal for
younger children, yet adaptable to any age group.
Extended Night Hike: A longer hike in the ancient forest by night. Students test their senses
of hearing, smell, and touch through sensory activities while learning about the adaptations
of nocturnal animals.
Living History Timeline: Interactive program that covers the human history of the area:
Native inhabitance to the mining era to the conservation movement and eventual wilderness
designation. Students act out each era in skits that are developed along with the help of
instructors/teachers/chaperones.
Sustainability Debate: Interactive program that uses a debate format to engage students in
issues of sustainable practices. A discussion of power, water, and food systems at Jawbone
serves as a platform for examining alternative energy and human impacts on the watershed.
Best for 7th grade and above
Ancient Forest Slideshow: Our classic slideshow that covers the natural history of Opal
Creek’s forests, what lives there, adaptations of plants and animals, etc. paired with an
outdoor activity.
Jawbone Jeopardy: Students compete as teams in a game show format science trivia game
with content derived from their studies while at Opal Creek. This is a great last night activity.
7 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Sample Itinerary for one-night visit School Name
Teacher/ Trip Organizer Name
# Students, # Chaperones
Lodging arrangement
Day 1:
12:00 Meet shuttle at gate, load gear in shuttle, group welcome
12:30 Begin hike into Jawbone
3:00 Arrive Jawbone Flats, snack, camp orientation
3:15 Teacher/Chaperone Orientation
6:00 Dinner & Chores
7:30 Evening Program: Evening in the Ancient Forest with Night Hike
9:00 Return to Cabins
10:15 Closing Circle
10:30 Begin hike to gate, Stewardship discussion and trash pick-up along the way
12:00 Depart gate for home
Sample Itinerary for two-night visit School Name
Teacher/Trip Organizer
Grade Level
Lodging arrangement
We recommend students eat lunch on the drive or upon arrival at the Opal Creek trailhead. Students will
need a sack lunch for the first day. The group must be ready to go at noon when the shuttle vehicle and
Opal Creek Instructors arrive.
Day 1:
12:00 Meet shuttle at gate, load gear in shuttle, group welcome
12:30 Begin hike into Jawbone
3:30 Arrive Jawbone Flats, snack, camp orientation
4:00 Scavenger Hunt, Teacher/Chaperone Orientation
4:45 Move into Cabins/Recreation Time **Supervised by teachers/chaperones**
6:00 Dinner & Chores
9:00 Return to Cabins
12:00 Lunch on the Trail
1:00 Interest Groups:
Group 1: Mineralogy
4:00 Journal/Art Time **Supervised by teachers/chaperones**
5:00 Recreation Time **Supervised by teachers/chaperones**
6:00 Dinner & Chores
8:45 Return to Cabins
10:15 Closing Circle
9 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Being Off-The-Grid Jawbone Flats is the forest campus where we host all of our programs. Our site is entirely off-the-
grid: you will not have access to phone service or internet connection in Jawbone Flats. Please
come prepared to be unplugged from the outside world during your time at Opal Creek!
Safety Safety is our number one priority at Opal Creek. Due to the remote nature of our site it is especially
important that students are supervised by a teacher or chaperone during all free periods and
throughout the night. Our Outdoor Science Instructors are Wilderness First Responders and will be
available throughout your stay to provide medical care and evacuate participants to higher medical
care if needed. When you arrive in camp you will receive a chaperone orientation on emergency
procedures. We have email, phone, and a Garmin InReach GPS as our forms of emergency
communication in camp.
Accommodations
Our cabins have varied floor plans, but all are dorm-style and have a bathroom on each
level. They are rustic but cozy. Every bed has a bottom sheet and a pillow.
You are responsible for bedtime: getting students to bed and imposing the lights-out and
quiet time policies by 10pm at the latest.
Each of our overnight accommodations has bathroom space, which is shared by students
and adults. Hot showers are available in some overnight accommodations, but we ask that
only groups staying more than two nights shower and that everyone keep their shower short
to conserve water and propane resources.
There are totes in every cabin to store extra food from lunches or snacks. Please secure all
food in the totes to deter rodent activity.
Meals
Meals are served buffet-style in the lodge. Meals in Jawbone Flats feature vegetarian,
healthy, and hearty food, and we provide kid-friendly options.
Chaperones help elementary and middle school students with serving and packing lunches.
We find this to be the best way to reduce food waste and serve students quickly.
Each class will be divided into groups to assist in chores, such as dishwashing, sweeping,
and wiping down tables.
One teacher or chaperone must be seated at each student table to supervise during
mealtime.
Opal Creek is a multi-use facility. There may be other guests with whom you will be sharing
meals!
10 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Opal Creek is a unique place where you have the opportunity to relax, explore, and have fun! It is
also remote, so everyone is asked to exercise caution at all times. We ask that each person be a
positive member of the Opal Creek community while you are visiting. As a chaperone, you help
enforce these guidelines:
Respect all students, chaperones, and staff members. Be open-minded and accepting of
people’s differences and respect their ideas.
Respect other people’s belongings.
Do not use inappropriate language or gestures.
Stay on the trails and behind your leader.
Be respectful to plants, animals, and the ecosystem as a whole.
Do not jump from bed to bed, pillow fight, rough house, or play fight in the cabins.
Students are prohibited from using their cell phones for any purpose other than to take
photos. Smart phones must be switched on to ‘airplane’ mode. Opal Creek Ancient Forest
Center reserves the right, with consultation with the Teacher Organizer, to remove a cell
phone from a student’s possession for the duration of his or her stay if it becomes a
distraction to other students.
No burning candles at any time.
Quiet hours are from 10:00pm to 7:00am the next morning. Please respect the needs of
others during this time.
Weapons of any kind are prohibited.
Drugs and alcohol are prohibited.
Chaperones are responsible for student supervision at all times. We require at least one
adult per 10 students in the cabins with students overnight and wherever students are
present.
Should any student choose to disobey these rules and refuse to cooperate after warnings and
disciplinary action, they may, at the discretion of Opal Creek Ancient Forest Center and upon
consultation with you as Teacher Organizer, be sent home.
As Teacher Organizer, you may also decide to send students home if the school’s own policies or
rules are broken. In any such event, the student's parent(s) or guardian(s) will be required to pick
up the student at Opal Creek.
We expect all adults and students to follow these rules without exception.
11 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Free Time Activities and Supervision
When students are not with Opal Creek Instructors, student supervision is the responsibility of the
group chaperones and teachers. Free time supervisory responsibilities include keeping track of your
students and watching out for their safety. We highly recommend planning for free time periods
before you arrive at Opal Creek. Some suggestions are:
1. Play sports or team games in the meadow:
We have limited sports equipment, so we highly encourage you to bring your own. If you
decide to bring your own equipment, please label items with your school's name in
permanent ink. Recommended sports to play in the meadow include soccer, Frisbee, and
softball.
2. Write in journals:
We encourage at least one time period each day when students are involved in some formal
writing assignment in their journals. Opal Creek will provide each student with a field journal
to be used during and after their trip. We encourage teachers to use them in the classroom
to reflect upon their trip afterwards!
3. Plan an art activity:
We have limited art supplies, so we encourage you to bring your own.
4. Play organized indoor games:
Sleeping accommodations can be used as a recreation space for board/card games and
quiet activities. You may want to bring a variety of indoor games such as board games or
cards.
5. Go to the creek:
Chaperones must always inform you as the Trip Organizer before taking students to any of
the creeks. Students must be accompanied by adult chaperones (at least 1 adult per 10
students) while at the creek. NO SWIMMING. The water can be cold and very swift.
12 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
REQUIRED FOR DAY HIKING:
(reusable lunch bag is preferable)
Day pack - large enough for lunch, jacket,
rain gear, water bottle and journal
Water bottle – durable, reusable
or poncho. Rain boots are encouraged.
Sunscreen
Hat
preferably waterproof for hiking.
good choice
sheet are provided.
April, early May, and October)
Warm hat and sun hat
Warm coat in April, early May & October
Pants - at least one extra pair
Shirts - extra as needed
Socks - one pair per day plus one extra (a
few thick hiking socks if possible)
Pajamas or nightwear
toothpaste, etc.
Personal medications as needed
Flashlight and extra batteries
Tupperware or reusable lunch
addition to hiking boots
Field guides
Money for Jawbone Flat Company
Store (Items cost between $1 and
$40; ex: t-shirt, water bottle, stickers)
DO NOT BRING
be included in your first day’s lunch.
Drugs or alcohol.
dryers or curling irons. We do not have
enough electricity to operate these
devices.
equipment.
Transportation
All Outdoor School programs begin and end at 12pm. Please plan your transportation
accordingly. There is sufficient space at the trailhead parking lot for a school bus to turn
around. If your transportation provider requires an address to complete your reservation,
‘the end of Forest Service Road 2209’ is the most accurate direction to give them. If
transportation is a school bus consider driving one extra vehicle in the event of evacuation
prior to the end of your trip.
At the trailhead, there are designated parking spots for OCAFC participants. Please park
personal vehicles in these spaces and make sure to get a registered guest tag from the
Opal Creek staff. All cars at the gate must also have a Northwest Forest. Passes cost $5 per
day per vehicle and are available at the gate in a self-serve kiosk, or as a $30 annual pass
available at many outdoors retailers.
Driving Directions We recommend following Google maps to “North Fork Rd., Lyons, OR.” After this point you will lose
cell service. Please follow the directions below when coming to Opal Creek. Typical driving times to
Opal Creek are: from Salem, 1.5 hr.; from Portland or Eugene, 2 ½ hrs.; from Bend, 2.5-3 hrs.
From 1-5:
Turn east onto Hwy 22. Continue for approximately 22 miles.
Turn left/north onto North Fork Rd- at the second flashing yellow light. On the right hand side of
the road you will see the North Fork Crossing Restaurant.
You are now out of cell range. The Opal Creek Trailhead is at the very end of this road, a total of
20 miles. This drive will take about 1 hour.
After 14 miles of pavement you will enter the Willamette National Forest where the road turns to
gravel. You are now on Forest Road 2209.
Please note: Forest Service Road 2209 is gravel and maintained on an irregular basis by the US
Forest Service. Expect to go no faster than 15-20 mph on this stretch of road.
After 1.5 -2 miles you will see a turn-off on the right towards Three Pools/Shady Cove. Stay to the
left on Forest Road 2209.
Continue another 4 miles to the Opal Creek/Jawbone parking area and trailhead.
From Bend, Hwy 97 or Hwy 20:
Drive west on Hwy 22 to the town of Lyons, OR.
Turn right/north onto North Fork Rd- at the first flashing yellow light. On the left hand side of the
road you will see the North Fork Crossing Restaurant.
You are now out of cell range. The Opal Creek Trailhead is at the very end of this road, a total of
20 miles. This drive will take about 1 hour.
After 14 miles of pavement you will enter the Willamette National Forest where the road turns to
gravel. You are now on Forest Road 2209.
Please note: Forest Service Road 2209 is gravel and maintained on an irregular basis by the US
Forest Service. Expect to go no faster than 15-20 mph on this stretch of road.
After 1.5 -2 miles you will see a turn-off on the right towards Three Pools/Shady Cove. Stay to the
left on Forest Road 2209.
Continue another 4 miles to the Opal Creek/Jawbone parking area and trailhead
14 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Registration Form – Required for ALL Participants
Please print clearly. Bring completed form to Opal Creek with you.
Group
Date of birth Grade Check if applicable: Teacher Chaperone
Address City, State, Zip
Phone number Parent/Guardian Email
(Secondary) Name and Relation
Health Information
List any behavioral or medical concerns that our staff should be aware of including food and/or drug allergies, required dietary
restrictions and their severity, prescriptions and dosages, etc. Due to our remote setting, we may not be able to fully
accommodate dietary restrictions other than the ones listed below.
Vegan Gluten/Wheat Dairy Egg Peanut/Tree Nut Fish/Shellfish Other
15 Opal Creek Ancient Forest Center • (503) 892-2782 • www.opalcreek.org
Release & Waiver – Required of ALL Participants
Acknowledgement and Assumption of Risks
I understand that during my participation in the activities or programs of Opal Creek Ancient Forest Center that I may
be exposed to a variety of risks and hazards, foreseen or unforeseen, which cannot be eliminated without
fundamentally altering the unique character of the program. These inherent risks include, but are not limited to,
environmental risks and hazards, including rapidly moving, deep, or cold water; insects, snakes, and predators,
including large animals; falling and rolling rock; lightning and unpredictable forces of nature, including weather that
may change to extreme conditions without notice. Possible injuries and illnesses include hypothermia, frostbite,
sunburn, heatstroke, dehydration, and other mild or serious conditions or injuries. Emergency evacuations and
medical care may be delayed due to the remote locations where program activities take place.
I understand that this description of the risks is not complete and that other unknown and unanticipated risks may
result in property loss, injury, or death. As a condition of my participation in this program, I agree to assume full
responsibility for all the risks that such participation may entail. My participation in this program is entirely voluntary,
and I elect to participate with full knowledge of the inherent risks.
Release and Indemnification
In consideration of participation in activities or programs of Opal Creek Ancient Forest Center I voluntarily elect to
assume all risks of loss or damage to any property or any injury, including death, and hereby knowingly, freely, and
voluntarily release and agree to indemnify and hold harmless Opal Creek Ancient Forest Center, its Executive Director,
its members, officers, staff, employees, volunteers, and agents from any and all liability, claims, demands, or causes
of action whatsoever by reason of any damage, loss, expenses, injury, or death arising in the course of participation
in this program and from any liability for any act or omission or negligence or strict liability in obtaining, rendering, or
failing to obtain first aid or any kind of emergency medical care.
This Release and Waiver of Liabilities shall be binding on the spouse, family, heirs, executors, administrators,
successors, and assigns of the participant.
I authorize Opal Creek Ancient Forest Center and its staff, employees, and volunteers to administer first aid and/or
emergency medical treatment and/or to secure such medical services that may be considered necessary.
I HAVE READ AND UNDERSTAND THIS RELEASE.
Participant Signature (if age 18 or older): Date:
Signature of Parent or Guardian: Date:
Promotional Materials and Photo Release
One of the best ways to explain our mission of connecting people to the natural world is through photographs and
testimonials of program participants. To help tell the story about the positive effect our programs can have, we
occasionally use these items in our promotional materials (e.g. brochures, newsletters, annual report, website, social
media, etc.).
I (or my parent if I am a minor) agree that any photographs or video of me taken by Opal Creek Ancient Forest Center
are the property of Opal Creek Ancient Forest Center and may be used by Opal Creek Ancient Forest Center at its
discretion for any publicity, marketing, and/or advertising purposes, and I hereby consent to and authorize such use
without restriction.
Signature of Parent or Guardian: Date: