Student Travel Forms

STUDENT TRAVEL FORMS

Student Information

Student Name:    Date of Birth:

Trip Details

School / Organization:    Advisor / Teacher:

Departure Date:    Departure Time:

Return Date:    Return Time:

Transportation & Accommodation

Select modes of transport to be used during this trip (check all that apply):

 School Bus / Chartered Bus
 School Van(s)
 Private Vehicle (designated driver):
 Airline / Commercial Carrier
 Other (specify):

Emergency & Medical Information

Relationship:    Phone:

 I authorize school personnel to administer prescribed medication to the student in accordance with written instructions provided by the parent/guardian and prescribing health professional.

Permissions, Acknowledgements, and Releases

In consideration of the student being permitted to participate in the trip described above, I, the undersigned parent or legal guardian, hereby grant permission for the student to participate and consent to the following:

1. Medical Treatment: If the student requires emergency medical attention while participating in this activity, I authorize school officials and supervising adults to obtain and consent to emergency medical treatment, including hospitalization, anesthesia, surgery, and any other medical care deemed necessary. I agree to be financially responsible for such treatment.

2. Release of Liability: I release and hold harmless the school, its board members, officers, employees, agents, volunteers and chaperones from any and all liability for personal injury, property damage, loss, or wrongful death which may arise out of or in connection with the student's participation in this trip, except to the extent caused by gross negligence or willful misconduct of the released parties.

3. Conduct and Compliance: I acknowledge that the student must abide by all behavioral standards, rules, and directives established for the trip. The student may be sent home at my expense for violations of rules or for conduct that, in the judgment of supervising staff, jeopardizes safety.

4. Photographs and Media: I authorize the use of photographs, video and audio recordings made during the trip that include the student for school-related publications, promotional materials, and educational purposes, unless I indicate otherwise by checking the opt-out box below.

 I do not authorize photographs, video or audio recordings of the student for promotional or public use.

5. Transportation Terms: I understand that travel will be by the modes indicated above and that the school will arrange carriers, drivers, and insurance consistent with its standard practices. I acknowledge that private vehicles used by event volunteers or parents are not operated by the school and that I accept responsibility for any additional risks associated with such transport.

6. Truthful Information: I certify that the medical, insurance, and emergency contact information provided on this form is complete and accurate to the best of my knowledge. I will notify the school promptly of any changes prior to departure.

Parent / Guardian Information

Relationship to Student:    Phone (Primary):

Additional Information / Special Instructions

I certify that I have read and understand the contents of this Student Travel Form, that the student named above has permission to participate as indicated, and that I agree to the permissions, acknowledgements, and releases contained herein.

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