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Field Trip Form

This parental consent form provides information about an upcoming field trip for students. It includes details such as the student and parent names, date and type of field trip, destination, supervising teachers, transportation details, costs if any, and medical emergency contact information. The parent agrees to let their child participate, releases the school and diocese from liability, and consents to emergency medical treatment if needed. They also provide optional medical information to assist with any care required.

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121 views2 pages

Field Trip Form

This parental consent form provides information about an upcoming field trip for students. It includes details such as the student and parent names, date and type of field trip, destination, supervising teachers, transportation details, costs if any, and medical emergency contact information. The parent agrees to let their child participate, releases the school and diocese from liability, and consents to emergency medical treatment if needed. They also provide optional medical information to assist with any care required.

Uploaded by

api-90835281
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FIELD TRIP

PARENTAL CONSENT FORM & INDEMNITY AGREEMENT


Student/Participant Name________________________________________________________
Date of Birth______________________________________Sex_________________________
Parent/Guardian Name__________________________________________________________
Home Address_________________________________________________________________
Home Phone___________________________________Business Phone___________________
Date of Event/Field Trip____________________Type of Field Trip________________
Destination_____________________________________________________________
Individual(s)/Teacher(s) in Charge__________________________________________
Estimated Time of Departure_________________________Return________________
Mode of Transportation to & from Event_____________________________________
Student Cost (if applicable)________________________________________________

I, _________________________________, grant permission for ________________________


Parent or Guardian Name

Child Name

to participate in the above named activity and I warrant that my child is in good health. In
consideration of my childs participation, I agree to indemnify the parish/school and the Diocese
of New Ulm from any claims or law suits brought against the parish/school/Diocese of New Ulm
by myself, my child or others, that arises out of any behavior by my child at the event/activity
described above. I also agree to pay reasonable attorneys fees or expenses incurred by the
parish/school and the Diocese in defense of such a claim/suit.
EMERGENCY MEDICAL TREATMENT: In the event of an emergency, I give permission to
transport my child to a hospital for medical treatment. I wish to be advised prior to any further
treatment by a doctor or hospital. In the event of any emergency, if you are unable to reach me
at the above numbers, contact______________________________ ______________________
Name

Phone Number

OPTIONAL MEDICAL INFORMATION:


Medication my child is taking at present____________________________________________
Family Health Plan carrier number________________________________________________
Family Doctor___________________________________Phone Number_________________
As Parent or Guardian, I agree to all of the above stated considerations and conditions.
______________________________________________________ _____________________
Signature

Date

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