This form must be signed and returned to the school if the
student(s) named below are to participate in field trips/extracurricular
activities throughout their years as a Skyline student.
Consent to Participate in Field Trip or other Activity and
Consent for Treatment
parent and legal guardian of
consent for my child to participate in (a) all field trips not going beyond the
boundaries of Pratt County and (b) all school sponsored athletic/extra curricular
trips regardless of location.
I further give my legal consent
and authorize any representative of Skyline School to authorize emergency
medical treatment, including any necessary surgery or hospitalization, for my
above named child(ren), for
any injury or illness of an emergency nature he/she incurred while
participating in the field trip or other activity noted above by any physician
or dentist licensed in accordance with the provisions of the Kansas Healing Aera Act, L.S.A. 65-2801, and any hospital.
I agree to pay and assume all
responsibility for medical and hospital expenses and any emergency services
incurred on behalf of my child.
I acknowledge and agree that
Skyline School is not responsible for any medical, hospital expenses and/or
other charges that are incurred in the medical treatment or hospitalization of
my child.A photocopy of this
document shall have the same force and effect as the original.If my child requires emergency medical
treatment, I understand the school personnel will make a reasonable attempt to
contact me to seek my permission to authorize that treatment.To facilitate contacting me, I agree to
continue to provide current work and home phone numbers to the school.