Student Ice Skating Event Permission Form

Student Ice Skating Event Permission Form

School Name:    Teacher/Advisor:

Event Details

Event Name:

Event Date:    Departure Time:    Return Time:

Venue Name:

Student Information

Date of Birth:    Student ID:

Grade/Program:    Homeroom/Period:

Parent / Guardian Information

Relationship to Student:

Emergency Contact & Medical Information

Physician Name:    Physician Phone:

Health Insurance Provider:    Policy/Group #:

Transportation Authorization

I authorize my child to be transported to and from the event by (check applicable):
  School bus/coaches provided by the school
  Parent/guardian or other approved adult vehicle
  Public or commercial transportation (e.g., charter bus)

Photographs and Media Release

I consent to the use of photographs, video, or other media of my child taken during the event for school-related educational, informational, or promotional purposes.

  I grant permission for media use
  I do NOT grant permission for media use

Assumption of Risk, Release, and Authorization for Medical Treatment

I understand that ice skating involves inherent risks, including slips, falls, collisions, and injuries that may result in bodily harm. By permitting my child to participate, I knowingly and voluntarily assume all such risks associated with this activity.

In consideration for allowing my child to participate, I hereby release, waive, discharge, and covenant not to sue the school district, school, event organizers, coaches, volunteers, employees, agents, and their successors and assigns (collectively, Released Parties) from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, or injury to person or property, including death, that may be sustained by my child while participating in the event, except to the extent caused by the gross negligence or willful misconduct of a Released Party.

I agree to indemnify and hold harmless the Released Parties from any loss, liability, damage, or cost, including reasonable attorneys' fees, they may incur due to my child's participation, whether caused by the negligence of a Released Party or otherwise, to the fullest extent permitted by law.

If medical treatment is necessary, I authorize school officials or designated chaperones to secure medical treatment and transportation for my child and to consent to any emergency medical care, including hospitalization, anesthesia, and surgical procedures as deemed necessary by licensed medical personnel. I agree to be responsible for costs associated with such treatment.

Conduct and School Policies

My child will comply with all school rules, directions of staff and chaperones, and venue regulations while participating. I understand that failure to follow behavioral expectations may result in my child being removed from the event and returned to the school or home at my expense.

By signing below, I certify that I have read this document, that I understand its terms, and that I am the parent or legal guardian of the student named herein and have the authority to consent on behalf of the student.

Acknowledgment (Initials)

Initial to acknowledge each statement:

Student is physically able to participate:    Medical information provided is complete and accurate:    Agreement to release and indemnify as stated above:

Sign Now