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KIDDIE KONNECTION 2707 Muscatine Ave. Iowa City, Iowa 52240

TRAVEL AND PICTURE AUTHORIZATION

I hereby do/do not (circle one) give permission for my child ___________________ _______________________to leave Kiddie Konnection for field trips in the Kiddie Konnection Van or public transportation to special places. I understand I will be notified before each such activity. Signature of Parent/Guardian_____________________________________________ Date___________________

PICTURE RELEASE

I hereby do/do not (circle one) give permission for my child _____________________ _______________________to be photographed by the center in newspapers or other media for the purpose of publicity or advertisements.

Signature of Parent / Guardian____________________________________________ Date____________________


Travel and Picture Authorization