The Pillowcase Project

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The Pillowcase Projec
.
Learn. Practice. Share
Your local American Red Cross chapter will be
presenting one of the first national Pillowcase
Project presentations to your student
on______________________!
Your student will receive and bring home a
pillowcase, designed to become a personal
emergency supplies kit, and a student
workbook, which will help them learn more
about natural hazards and help your family
prepare for emergencies!
Please help us document our success in
piloting this valuable program by signing and
returning the release form on the back of this
flyer. Please contact the teacher or counselor
from whom your student received this flyer
with any questions. Remember, you can
always visit redcross.org for more information
about our services and preparedness tips for
your family and workplace!
Danielle Carder
816.841.5237
Your student will:
* Learn emergency
preparedness skills for
themselves, their family,
and the community
* Learn helpful coping skills
for stressful situations
* Receive a pillowcase,
workbook, and completion
certificate to bring home!
The Pillowcase Project
Learn. Practice. Share.
Please fill out the following form (in English or Spanish) and return it with your student to class
or with the program where this presentation will be given no later than________________________.
INFORMATION RELEASE
AUTORIZACIÓN PARA EL USO Y
DISTRIBUCIÓN DE INFORMACIÓN
I give to the American Red Cross, its designees, agents
and assigns, unlimited permission to use, publish and
republish in any form or media, information about me and
reproductions of my likeness (photographic or otherwise) and
my voice, with or without identification of me by name.
Autorizo a la Cruz Roja Americana y a sus designatarios,
representantes y agentes a usar y publicar sin restricciones y
cuantas veces sea necesario, bajo cualquier forma o medio,
información referente a mi persona incluyendo reproducciones
de mi retrato (fotográficas o de otro tipo) o de mi voz, con o
sin mi nombre.
Name of person photographed, recorded or interviewed
(Please print)
Age (if minor)
voz ha sido grabada (Por favor use letra de imprenta.)
Street address, city, state and ZIP code
Dirección (calle, ciudad, estado y código postal)
E-mail / Phone number
Correo electrónico/Número de teléfono
Signature
Date
Firma
Edad (si es menor de edad)
Fecha
I consent and agree, individually and as parent or legal
guardian of the minor named above, to the foregoing
terms and provisions.
Consentimiento del padre/madre o representante legal si la persona
anteriormente mencionada es menor de edad. Consiento y apruebo,
individualmente como padre/madre o representante legal del
menor de edad arriba citado, a los términos y estipulaciones de la
presente autorización.
Signature
Firma
Consent of parent or legal guardian if above individual is a minor.
Date
Printed Name / Relationship
Nombre en letra de imprenta / Vínculo
Producer, writer,or photographer
Productor, escritor o fotógrafo
Event / Location
Caption Info / Description of photo
Image number
Acontecimiento/Lugar
Fecha
Imagen núm.