DEPARTMENT OF THE ARMY
Junior Reserve Officer Training Corps
Blackman High School
3956 Blaze Drive
Murfreesboro, Tennessee 37128
1 September 2017
Subject: GENERAL RELEASE/PERMISSION FORM FOR ______
(Print name of Student)
TO: Senior Army Instructor and Army Instructor at Blackman High School
- I, ______grant permission for my child, ______
(Print Name of Parent/Guardian) (Printed Name of Student)
to participate in the JROTC Adventure Training Canoe Trip to be held on Wednesday, 20 September 2017 at the Duck Canoe Outfitters, Lewisburg, TN.
a. The pick-up and departure point for this trip will be in the Main Gym near the front of the school. All cadets will ride the school activity bus to and from this activity. Colonel (Ret) Spry and Sergeant Major (Ret) Sanders will be driving the buses.
b. We have 252 cadets in our program and we have only 2 buses. The buses will hold only 120 cadets. The first 120 cadets to return this form, $20 and the teacher approval form, which signifies that the cadet is in good academic standing in each of his/her classes, will get to go.
2. Your child will always be under the supervision of a JROTC instructor. This trip will cost $20. The JROTC cadre must receive this release form no later than Monday, 13 September 2017. The noon meal will be provided to all participants. The departure time is 7:15 am; the return to school time will be at approximately 3:00 pm. Students must arrive at school by 6:00 am. Prior to the event date, cadets will be briefed on items to bring and the appropriate clothing to wear during the event. All Cadets will wear life jackets. All Cadets participating in this event will be required to comply with County and JROTC policies. Any misconduct will result in appropriate disciplinary actions.
3. In case of emergency, I hereby authorize the JROTC instructor to take my child to the nearest doctor or hospital. I have adequate health insurance with ______Policy # ______. In case of an emergency, you will be able to contact your child via Colonel(Ret) Spry, BHS JROTC Senior Army Instructor; cell# (615)-684-2412 or, Sergeant Major (Ret) Sanders BHS Army Instructor; cell# (615)-969-3450 .
4. I/We do hereby agree to release, and otherwise hold harmless, all US Army retire officers and non-commissioned officer instructors, advisors, the US Army, school administrative officials, and the Rutherford County Department of Education from any and all liability for personal injury, property or other type of loss which occurs as a result of the aforementioned activity, to me or any of undersigned. I/We understand and agree that my signature hereunder constitutes a waiver of my rights by myself or my estate to sue, for any personal injures, death or property damage caused by, or as a result of the activity of, the herein above named parties, and I/We freely assume all risks, hazards, or losses which may result from said activity. JROTC instructors, school, and Rutherford County officials will make every reasonable effort to supervise, control, and render safe training and activities related to this unit of instruction.
______
(Signature of Parent)
Home Phone______Cell Phone ______