PARENT PERMISSION FOR STUDENT PARTICIPATION
Please sign and return to Mrs. Mallory by
date
has my consent and authorization to participate in
student’s first and last name
which involves
activity
This activity will be on
date
from / to / Students should arrive at / by
time / location / Time
è / Number of People Attending:
Transportation:
The district will not provide transportation for this field trip. Parents will be responsible to provide transportation for their students.
I authorize qualified emergency medical professionals to examine, and in the even of injury or serious illness, administer emergency care to the above named student. I understand every effort will be made to contact me to explain the nature of the problem prior to any involved treatment.
In the event it becomes necessary for the school district staff-in-charge to obtain emergency care for my student, neither s/he nor the district assume financial liability for expenses incurred because of the accident, injury, illness, and/or unforeseen circumstances.
Although I understand that the school district will make every reasonable effort to provide a safe environment, I am fully aware of the special dangers and risks inherent in participating in the activity, including physical injury, death, or other consequences arising or resulting from the activity.
I understand that money paid for the field trip cannot be refunded if my child is unable to attend.
I understand that all school and district policies are in effect on field trips. I understand that if my student violates one of these policies, my student may be sent home immediately at my expense.
Parent/Guardian Name: / Home phone:Work phone: / Ext: / Cell/Pager:
Address:
Medical conditions, medical information, or allergies district personnel should be aware of:
In the event of an emergency, I wish the following person(s) to be notified in case I cannot be contacted:
Name: / Phone:
Name: / Phone
Being fully informed as to these risks, I hereby consent to the student participating in the activity.
signature of parent/guardian / date