Adult's (parent/guardian) relationship to the minor/student:

Grade

Name of school student is currently attending:

Parent/Guardian Section

Code of Conduct - Parent Agreement

At all SunHouse programs, events and trips we expect our staff, volunteer leaders, and students to uphold our values of safety and respect. If our staff feels a student has said or done something that violates these values, we will remove the student from the activity. An immediate parent/guardian phone-call will occur, and we may ask the parent/guardian to come pick up their child before the activity’s scheduled conclusion. In some circumstances, we may ask that your child takes a one-week break from programs before returning to SunHouse. Please talk with your child about our expectations for behavior and conduct! All students should keep their hands and feet to themselves at all times. We have a zero-tolerance policy for inappropriate contact. One seat per person. No lap-sitting or sharing seats. No hate-speech or slurs of any kind. We have a zero-tolerance for any form of bullying. Do not spend unnecessary time in our restrooms. Use restrooms when needed, then promptly re-join the program. Phones are collected and stored safely in the phone-zone. Practice mutual-respect. Our staff and volunteers care for you; please respect their instruction and leadership. Please sign, acknowledging you have reviewed the code of conduct with your child:

Who does the student reside with?

Please select an option

Mother's Email

Father's Email

Emergency Contact's relation to student

Emergency Contact Phone Number

Please indicate the t-shirt size for your child.

Medical Section

Does your child have any allergies?

Please list any allergies below:

If none, please write "none"

Activities: my child can fully participate in all activities, except for the following

List the activities your Minor/Student can't participate in (if none, please write none)

Digital Signature

I give consent for my child to be treated.

Medical Insurance Provider

Insurance certificate number and/or group number:

Physician Section

Primary Care Physician's Name

Primary Care Physician Office Phone Number

Digital Signature- I agree that the above information is true and correct. I have agreed to submit this permission form by electronic means. By signing this permission slip electronically, I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

This form is not completed until you send a picture of your ID / driver’s license to sunhouseonline@ljpres.org to identify your digital signature.

2025 Medical & Permission Form

(858) 729-5507 • 7715 Draper Ave, La Jolla, CA 92037