Travel Permission Slip

Permission is requested for your child (student) to go on a field trip. To give permission for your child to attend this field trip complete this form.

Student First Name *

Student Last Name *

Student Birth Date * +

Parent Guardian First Name *

Parent/Guardian Last Name *

Parent / Guardian Cell: *

Parent / Guardian Email:

Physician name: *

Physician Phone: *

Trip Info

Destination *

Lodging (if applicable) *

Date of Departure *

Date of Return *

I agree and my child agrees to abide by all rules and safety precautions relating to this field trip activity. I understand that participation in this actiity is a privilege not a right and I am aware that during this trip certain risks are inherent. I understand that this field trip activity may involve certain conditions, hazards and potential dangers, including those associated with traveling in the above noted method of travel or those associated with the facilities or property where the field trip will occur or whether the dangers are open and obvious or concealed.I knowingly and freely assume all such risks, whether known or unknown, even if arising from the negligence of the Releasees or others. My child/I, for themselves/myself, and on behalf of their/my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS THE KNOX SCHOOL, their officers, officials, agents, and/or employees, other participants, landowners, sponsoring agencies, (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my child’s/my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. Any questions which have occurred to me have been answered to my satisfaction. I am/my child is participating in these activities of my/their own free choice. My signature acknowledges that I have been informed of the reasonably expected hazards associated with the field trip in which I/my child will be participating. I further agree to accept responsibility for any negligent, willful, or intentional act of myself/my child and as a result will indemnify and hold harmless the School for all costs, damages and attorneys fees. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. In the event of an emergency, reasonable attempts will be made to contact the parent. This would not prevent the emergency health care provider from acting in the best interests of the child. I authorize emergency medical treatment for my child in the event of accident or illness during this field trip.

Check here letting us know whether or not your student wears a medical alert or has severe allergies or medical condition, and explain in the notes section below. *

Yes

Notes:

Parent/Guardian Please Sign which indicates that you agree to the above *

clear

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