I understand that my child will be attending ‘Teen Scene’ at the Benton County Library.  I further understand that part of the programs will include movies, based on books or chosen book themes, and that these movies will be rated above PG.  By my signing, I agree for my child to participate in this program and view the materials chosen by the library staff.  I understand that I will have advance knowledge of the movie my child will see, and the rating, and may choose not to have my child participate. I understand there may be associated field trips and I may choose to have my child attend and ride the bus or not.

Name of Child______________________
Name of Parent_____________________
Parent Signature____________________
Date______________________________

The ‘Teen Scene’ Program for this quarter will be held on June 20th-21st. The theme for this program is Find What's Out There (Aliens). The library will be showing the movie Signs (and other alien movies rated PG-13 and below). The program will start at 5:00 p.m. Friday and end at 7:00 a.m. Saturday, please be prompt in picking your children up at the library. They will be fed dinner, snacks, and a light breakfast.

We will not be leaving the library for any associated activities with this program.
OR (highlight one)
We will be leaving the library for the following activity___________________. 
We will travel by school bus to______________at _______________ (time).

By my signature below I give permission for my child ___________________ to participate in the program outlined above, see the movie, and ride the bus to attend associated activities, and state that I have read the plan and agree to the program for this quarter.

Name of Parent ______________________________
Parent Signature______________________________
Emergency Contact Number____________________
Childs Name________________________________

*All permission slips and registration for programs must be completed and turned in one week before the program to guarantee your child’s space.