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Permission Form - Kmhs 3 30 16

The document is a permission form for a one-day field trip for 160 students and 13 teachers from Kennesaw Mountain High School to see a play called "Dr. Seuss is Loose" at Cheatham Hill Elementary School on March 30th. The form notes the trip will use Cobb County School District buses, depart at 9:45am, return around 12pm, and requests a $5 donation per student. It requires signatures from students (if over 18) and parents to acknowledge risks and authorize any necessary medical treatment.

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368 views1 page

Permission Form - Kmhs 3 30 16

The document is a permission form for a one-day field trip for 160 students and 13 teachers from Kennesaw Mountain High School to see a play called "Dr. Seuss is Loose" at Cheatham Hill Elementary School on March 30th. The form notes the trip will use Cobb County School District buses, depart at 9:45am, return around 12pm, and requests a $5 donation per student. It requires signatures from students (if over 18) and parents to acknowledge risks and authorize any necessary medical treatment.

Uploaded by

api-301904910
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Cobb County School District

Form IFCB-4

A community with a passion for learning!

PERMISSION TO PARTICIPATE IN ONE DAY FIELDTRIPS


Teacher Name

School Name

Cheatham Hill

GENERAL INFORMATION
Destination Site:
Date/s of Trip:

Kennesaw Mountain High School

Wed., March 30

Approximate Departure Time:

Donation Requested per Student: $

Method of Transportation:

Approximate Number of Participating: Students:


Additional Teacher Comments:

9:45

160

12:00

Approximate Return Time:

CCSD Bus
Adult Supervisors:

13

Going to see the play, Dr. Seuss is Loose.

Wear your class t-shirt


The District does not or may not carry any insurance relative to the trip, including the cost of the trip, or
for injuries to the student. I represent that the student has insurance either through the student accident
insurance offered by the District or through my own insurance carrier.
I (Parent/Guardian Name-PLEASE PRINT):
acknowledge that
participation in the field trip described above is not mandatory and that a quality alternative instructional
experience will be provided to those students choosing not to participate.
I request that (Students Name-PLEASE PRINT):
be allowed to
participate in the field trip described above and specifically consent to his/her participation.
If any emergency medical procedures or treatment are required during the trip, I consent to the trip supervisor(s)
taking, arranging for or consenting to the procedures or treatment in his/her or their discretion.
I agree to release, indemnify, and hold harmless the Cobb County School District (District), its Board of Education,
and its employees, agents, or assignees, as well as its approved adult trip supervisors (District Indemnitees) from
and forever promise not to sue them on any and all claims, demands, rights, causes of action, liabilities, losses,
damages, costs and expenses (including reasonable attorneys fees), whether known or unknown, that I, any other
parent or guardian of the above-named student, or the student may have or may allege to have against the District
Indemnitees or which may be brought against the District Indemnitees arising out of or in any manner relating to
the students participation in the field trip, including but not limited to the rendering of emergency medical
procedures or treatment.

NOTE: This form must be signed by student if the student is 18 years of age or older.

Name of Student (PLEASE PRINT)

Signature of Student

Date

Name of Parent/Guardian (PLEASE PRINT)

Signature of Parent/Guardian

Date

2/28/06

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