Parent Pot-Luck Dinner Participation Request Form

Name

Directions: Please read the entire document, circle the appropriate responses, and sign your name at the end of the document stating that you will participate in the events. Thank you in advance for your consideration in this matter.

Investing in your health now can mean less chance for health conditions in the future. Look at your parents or grandparents; do they have any health conditions? Genetics can play a part in our chances for getting certain disease. Genetics are characteristics that we inherit from parent to child. For example, eye color, hair color and height are all determined by the parent’s attributes. Health conditions also run in families. Parents pass on certain health risks to their children. Eating well, being physically active, and not using tobacco can help us lower our chances for many diseases.

It’s important to know your risk factors and understand how being healthy can help you now and later in life.

The Parent Pot-Luck Dinner is a program designed to get children involved in creating a healthy meal. It also serves as an event to inform parents about different health issues that can affect their family tree. Parents are responsible for finding a healthy recipe, making the dish with the student, and bringing the recipe and the dish in for the student on the Parent Pot-Luck Day. The student is responsible for helping the parent make the dish, discussing their research project concerning the family tree and summarizing the cooking process for the healthy dish. The final student presentation will be given on the night of the Parent Pot-Luck Dinner. Each parent-student team will be judged based on the best presentation and the healthiest dish. The winning team will be awarded.

This year the Parent Pot-Luck Dinner will be held on:

(Date) _______________________, _________ at (Time) ___________.

Would you be willing to participate in the Parent Pot-Luck Dinner and create a dish with your child to be shared during the Parent Pot-Luck Dinner?

Yes No

Please remember to bring in a copy of the recipe on the day of the Parent Pot-Luck Dinner.

Signature: ________________________________________ Date:_______________

Non-profit Tax ID # 203478467