Parent Permission Slip for Field Trip To

Parent Permission Slip & Release for offsite trip:

Thursday, August 7, 2014 - Sunday, August 10, 2014

Hocking Hills Retreat

Hocking Hills Serenity Cabins - Rocky View Lodge, Logan, Ohio

Hocking Hills State Park & Fox's Canoe Livery

(If a permission slip is not completed and turned in, the child will not be allowed to go)

I,______give permission for my son/daughter,

(parent/legal guardian)

______to attend the field trip to ______

(child's name) (location)

on ______.

(date)

EMERGENCY INFORMATION

Full Name: / Birth date:
Address:
Parent(s) / Guardian Name / Parent(s) / Guardian Name
Home Phone #: / Mobile #:
Hospital Preference (if time permits):
Health Insurance Company: / Policy #:
Doctors Name: / Phone #:
Emergency Contact: / Phone #:
Emergency Contact: / Phone #
List any health problems your child has that would be important for medical personnel to know:
List any medications child is currently taking:
List any known allergies:

By executing this Release and Parent Permission slip and granting the permission stated herein, I, for myself, heirs, personal representatives and/or assigns, hereby release Calvary Evangelical Lutheran Church and its respective officers, directors, agents, employees from and against any liability, damages, claims or causes of actions arising out of my child’s participation in this trip, except as otherwise provided by law.

I also agree to indemnify and hold harmless Calvary Evangelical Lutheran Church from any claims, causes of action, or other judicial proceedings, costs, expenses, damages and liabilities, including attorneys’ fees, brought solely as a result of my child’s negligence, willful misconduct, and/or failure to adhere to the rules set forth by Calvary Evangelical Lutheran Church and/or its representatives either verbally or in writing.

Parent’s Signature:______Date:______