FIELD TRIP PERMISSION FORM

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

I,

the parent and legal guardian of

give my 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.

PRINT THIS DOCUMENT, THEN SIGN AND DATE

 

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(Parent or Legal Guardian)                                                                  (Date)

 

 

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 (Parent or Legal Guardian)                                                                 (Date)