Parent/Guardian Permission For

Parent/Guardian Permission For

FriendsAcademy

PARENT/GUARDIAN PERMISSION FORM

TRIP to: Camp DeWolfe

Date: September 15th, 2016– September 16th, 2016

(Unless FriendsAcademyreceives this completed form prior to the trip, your child will NOT be permitted to participate.)

Goal:

This trip allows seniors to work collaboratively as a community in planning senior events, develop an understanding of their leadership role as seniors, encourage class spirit, and unscheduled time for the students to be together and bond as a class!

Permission to Participate

My child______may participate in Friends AcademySenior Retreat. I permit him/her to travel by bus, provided by the school, and to return to Friends Academy upon completion of the Trip. I further acknowledge that I am responsible for my child’s safe transportation from the above-referenced return point after the Trip, and that I will make arrangements for his/her return home.

Consent to Treat

I understand that the School Teacher in charge of the Trip will have a copy of my child’s Student Health Form, which I completed. In the event my child should sustain an injury while participating in the Trip and the teacher in charge, or other adult chaperone, is unable to contact me to obtain timely consent for treatment, I authorize the teacher in charge to exercise their judgment in the interest of my child’s welfare by securing appropriate medical care, including first aid, emergency medical care, and if necessary, admission to a health care facility for treatment. I also give permission for the Student Health form to be released to those health care providers or health services who may need the information in order to treat my child in a medical emergency and to release any health information required to process an insurance claim. Any qualified medical personnel are hereby notified that this authorization is current in effect and such personnel are directed to act upon such authorization without delay.

Release from Liability

I am aware that all travel can be a dangerous activity involving risks of serious injury and even death. I understand that although the Teacher at the School intends to lead the Trip, and that although local guides and a representative of the School will also chaperone the Trip, my child may be unsupervised at times during his/her participation in the Trip. I agree that the School is not an insurer of the health or safety of my child and does not assume responsibility for spontaneous and unforeseen events, which may occur during his/her participation in the Trip.

I acknowledge that my child must strictly adhere to all School and Trip rules and instructions during the Trip and also state that, to the best of my knowledge, my child is in good health and suffers no disability or condition which renders his/her participation in the Trip medically inadvisable, or otherwise limits him/her to engage in this activity.

In consideration of the School permitting my child to participate in the Trip, I hereby, on behalf of myself, my children, spouse, heirs, agents, executors, administrators, and assigns, release and forever discharge the School, its agents, trustees, officers and employees, for any and all liability, demands, claims, damages, actions, and causes of action, pertaining to or arising out of my son or daughter’s participation in the Trip or release of medical information, including but not limited to, claims for negligence, personal injury, invasion of privacy, breach of contract, or breach of warranty, except in the event of gross negligence or willful misconduct. I understand that as a result of my executing this release, I will be forever barred from suing the School as a result of my child’s participation in the Trip.

Signature of Parent/Guardian: ______Date:______

Please Return Form no later than: Thursday, September 6, 2016

Packing Information

  • Bring a sleeping bag, pillow and pillowcase.
  • There is no need to bring any valuables or money.
  • Bring any toiletries that you will need for the overnight.
  • Bring a refillable water bottle.
  • Bring a swimsuit, towel and flashlight.
  • Bring sunscreen and bugspray - you will be outside a lot
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