Student Canopy Tour Permission Form

STUDENT CANOPY TOUR PERMISSION FORM

Student Information

Date of Birth:    Student ID:    Grade/Program:

Event Details

Activity:    Event Date:    Location:

Departure Time:    Return Time:

School bus or district transportation     Parent/guardian drop-off and pick-up     Other:

Parent / Guardian Information

Phone (primary):    Phone (alternate):

Emergency & Medical Information

Emergency Phone:    Relationship:

Currently taking medication: Yes    No    If yes, list medication(s):

Physician Name:    Physician Phone:

Health Insurance Company:    Policy Number:

Permissions, Acknowledgments, and Release

I, the undersigned parent or legal guardian (or adult student if age 18 or older), hereby grant permission for the student named above to participate in the canopy tour and associated activities on the date listed above. I acknowledge that canopy tours involve inherent risks, including but not limited to falls, collisions, equipment malfunction, weather-related hazards, and injuries that may result from strenuous activity.

Assumption of Risk: I understand and accept these risks on behalf of the student and agree that participation is voluntary. I certify that the student is physically capable of participating in the activity and that any restrictions have been disclosed in the medical information provided.

Release and Indemnification: In consideration of the student being permitted to participate, I release, waive, discharge and covenant not to sue the school district, its officers, employees, agents, volunteers, or contractors for any and all liability, claims, demands, actions or causes of action for bodily injury, property damage, or wrongful death arising out of or related to participation in the canopy tour, whether caused by negligence of the released parties or otherwise, to the fullest extent permitted by law. I agree to indemnify and hold harmless the released parties from any loss, liability, damage, or costs they may incur arising from the student's participation.

Emergency Medical Authorization: If the undersigned cannot be reached in an emergency, I authorize authorized school personnel or their designated agents to seek emergency medical treatment for the student, and to consent to such treatment, including administration of anesthesia, as may be deemed necessary by medical personnel. I agree to assume responsibility for any medical expenses incurred.

Behavioral and Safety Standards: I acknowledge that the student must follow all safety instructions, wear required safety equipment, and comply with staff directions. The school or activity provider may remove the student from participation for safety or disciplinary reasons; in such event, I remain responsible for any costs incurred and for arranging transportation.

Photography/Video Release: I grant permission for the student to be photographed or video recorded during the activity and understand that such images may be used by the school for educational or promotional purposes without compensation.    I do not grant permission.

Transportation Acknowledgment: I consent to the transportation arrangements indicated above and understand that additional parental permission may be required for certain off-site transportation methods.

Acknowledgment and Certification

By signing below I certify that I am the student's parent or legal guardian or the adult student, that I am authorized to sign this document, and that the information provided on this form is accurate and complete to the best of my knowledge. I understand that this document constitutes a legal and binding release and that I have had the opportunity to ask questions regarding the activity, the risks involved, and the protections in place.

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