As the parent/guardian of the above-named student under age 18 and/or chaperone, I understand I must sign this form before my student or I may participate in the field trip and acknowledging the following:

• I give permission for my student to / I will as a chaperone participate in this field trip and be transported as noted above.
• I have read the field trip itinerary and understand that there may be risks of physical injury associated with participation in the activities.
•  I also understand that participation in the field trip will involve activities off school property; therefore, neither the school district, the school or its employees and volunteers will have any responsibility for the condition or use of any non-school property.
• I authorize qualified emergency medical professionals to examine, and in the event of injury or serious illness, administer emergency care to, the above-named student. I understand effort will be made to contact me and emergency contact(s) listed above to explain the nature of the problem prior to any involved treatment. In the event it becomes necessary for the school staff-in-charge to obtain emergency care for my student, neither he/she nor the school or district assumes financial liability for expenses incurred because of the accident, injury, illness and/or unforeseen circumstances.
• I agree to inform the school nurse and/or principal at the school named above, as appropriate,ofany health issues or changes in health status that may affect or limit my and/or my child’s participation in the field trip listed above, including, but not limited to, medications being taken, dates of hospitalization in the last year and the reasons for any such hospitalization, any illnesses and any other special health-related issues.
• The field trip is an extension of the school education program and student conduct is to be in accordance with the school’s published rules and regulations