Student Trip Permission Form

Student Trip Permission Form

Trip Details

Trip Name:

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

Student Information

Date of Birth:    Student ID:    Grade / Program:

Parent / Guardian Information

Relationship:    Primary Phone:    Email:

Emergency Contact

Emergency Contact Name:    Relationship:

Phone:    Alternate Phone:

Medical Information & Authorization

Physician Phone:    Health Insurance Provider:

I authorize designated school personnel to administer prescription medication to my child as directed in writing by me and/or the prescribing health care provider.
I authorize administration of common over-the-counter medication (e.g., acetaminophen, ibuprofen, antihistamine) per standard dosing instructions unless otherwise directed below.

Transportation & Supervision

Mode of Transportation (select all that apply):

School bus or chartered bus    Private vehicle driven by staff/volunteer    Walking

I grant permission for my child to travel via the modes indicated above and agree that supervisors may make reasonable decisions for safety and welfare during the trip in accordance with school policies.

Media Release

I consent to the photographing, audio recording, and/or videotaping of my child during the activity and authorize the school to use such media for educational, archival, or promotional purposes consistent with school policies.
I do not consent to media use; my child should not be photographed or recorded for promotional use.

Liability, Release & Indemnification

In consideration of my child being permitted to participate in the above-described trip, I, on behalf of myself and my child, acknowledge and agree that participation involves inherent risks. I release, waive, discharge and covenant not to sue the school, its employees, volunteers, chaperones, agents and representatives from any and all liability, claims, demands, actions or causes of action arising out of or related to any loss, damage, injury or death to my child or property that may occur as a result of participation in the trip, whether caused by the negligence of the released parties or otherwise, to the fullest extent permitted by law.

I further agree to indemnify and hold harmless the released parties from any loss, liability, damage or cost they may incur due to my child's participation, including reasonable attorneys' fees and costs, except where prohibited by applicable law.

Acknowledgment & Emergency Authorization

By signing below I certify that I am the parent or legal guardian of the named student and that the information provided on this form is true and correct to the best of my knowledge. If an emergency occurs and I cannot be reached, I authorize the school and its agents to seek and consent to emergency medical treatment for my child, including but not limited to transport to a medical facility, and to authorize treatment as deemed necessary by licensed medical professionals.

I acknowledge that I have disclosed all known medical conditions, allergies and medications, and I agree to provide any necessary medical supplies and written instructions. I understand that I am responsible for all costs of medical care and transportation.

Special Instructions / Additional Information

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