Student Field Trip Form

STUDENT FIELD TRIP FORM

STUDENT INFORMATION

Student Name:

Date of Birth:    Student ID:

PARENT / GUARDIAN INFORMATION

Relationship:    Day Phone:

TRIP DETAILS

Destination:

Trip Date(s):    Departure Time:    Return Time:

Mode of Transportation:

MEDICAL INFORMATION & AUTHORIZATIONS

Physician Phone:    Health Insurance:

  I authorize school staff to administer routine over-the-counter medications (e.g., acetaminophen, antacid, antihistamine) as deemed appropriate according to school policy.

  I authorize designated staff to administer prescription medication in accordance with written instructions I provide and with original labeled prescription container.

EMERGENCY AUTHORIZATION & LIABILITY RELEASE

By signing below, I certify that I am the parent or legal guardian of the student named above, or that I am the student and am 18 years of age or older. I authorize my child to participate in the activity described above and acknowledge that participation involves inherent risks. I grant permission for school personnel to obtain emergency medical care and to arrange transportation in the event of illness or injury if I cannot be reached. I understand that reasonable efforts will be made to contact me prior to treatment when practical, but if immediate treatment is necessary, I authorize medical personnel to provide care.

I release and hold harmless the school district, its officers, employees, volunteers, and agents from any and all liability, claims, or causes of action for personal injury, loss, or damage to property arising out of participation in this trip, except to the extent caused by willful or grossly negligent conduct. I agree to indemnify the district for any claims brought by third parties related to my child's conduct or negligence.

I agree to disclose any behavioral concerns or conditions that may affect my child's safety or the safety of others. I acknowledge that failure to follow established rules may result in disciplinary action and possible exclusion from activities without refund.

CONSENTS & ACKNOWLEDGMENTS

  I consent to allow photographs or video recordings of my child taken during the trip to be used by the school for educational, informational, or promotional purposes, provided no personal contact information is disclosed.

  I consent to my child being transported by the mode of transportation described above and acknowledge that operators are licensed or authorized as required by law.

  I have reviewed trip rules and behavioral expectations with my child and understand consequences for noncompliance.

ADDITIONAL INFORMATION

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