Educational Parental Permission Form

EDUCATIONAL PARENTAL PERMISSION FORM

School/Organization:

Student Information

Date of Birth:    Student ID:    Grade/Program:

Parent / Guardian Information

Relationship to Student:    Primary Phone:

Secondary Phone:    Email:

Event / Activity Details

Event Date(s): From to

Location:

Departure from School:    Estimated Return to School:

Transportation Authorization

I authorize my child to travel via the following (check all that apply):

School vehicle (bus, van)    Volunteer/private vehicle    Public transportation    Walking

Medical Information & Authorization

Primary Care Physician:    Phone:

I authorize school personnel to assist in administering prescribed medication pursuant to school medication policies: Yes    No

Emergency Contact (other than parent):    Phone:

Authorization for Emergency Medical Treatment

In the event of illness or injury and if reasonable attempts to reach the parent/guardian have been unsuccessful, I hereby authorize the school officials to arrange for and consent to emergency medical or surgical treatment for my child. This authorization includes transportation to an appropriate medical facility and any medical treatment deemed necessary by a licensed physician or emergency medical personnel. I understand that the school will make reasonable efforts to notify me as soon as practicable. I agree to assume financial responsibility for any medical expenses incurred as a result of such treatment, except to the extent covered by the student's health insurance.

Photo / Video Release

I grant permission for my child's image and/or voice to be photographed, videotaped, or otherwise recorded and used by the school for educational, promotional, or informational purposes, including printed materials and internal presentations, subject to school policy.

I consent to photograph/video release    I do not consent

Behavioral Expectations & Discipline

I acknowledge that my child is expected to comply with all applicable rules of conduct while participating in this activity. The school reserves the right to send a student home for disciplinary reasons or for safety concerns. I agree to assume responsibility for arranging and paying for transportation if my child is sent home for such reasons.

I have reviewed the behavior expectations with my child and understand the potential consequences for failure to comply with rules, including removal from the event.

Liability Waiver and Indemnity

By signing below, I acknowledge that participation in the event may involve inherent risks. To the fullest extent permitted by law, I release and hold harmless the school, its employees, volunteers, agents, and representatives from all liability for personal injury, property damage, or other loss arising out of or in connection with my child's participation, unless caused by the gross negligence or willful misconduct of the released parties. I agree to indemnify and defend the released parties against any claims arising from my child's actions.

Special Accommodations

Acknowledgment

I affirm that the information provided on this form is true and complete to the best of my knowledge. I understand and agree to the medical authorization, transportation permissions, photo/video release choice, behavioral expectations, and liability waiver set forth herein. I will notify the school promptly of any changes to the information provided.

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