Avon Grove School District: Field Trip Permission Form

We/I as parent(s) or legal guardians(s) of ________________________________ give permission for

Student’s Name

our child to participate in: the Avon Grove Singers and Gold Band ensemble

Field Trip:to Chatham Acres and Jenners Pond Nursing Homes Date of Trip: Monday December 22, 2008.

This permission includes all related programs or events associated with the field trip.

In order for the school district to be able to provide this school-sponsored field trip and to reduce the costs of insurance and the risks of liability to the school district related to the provision of this school-sponsored field trip, the school district seeks your agreement to release it from liability for any claims for injury to person or property that may arise in connection with the field trip.  We/I understand that there are certain risks inherent in the nature of the activity related to the field trip, that we/I have knowledge of these risks or have had the opportunity to obtain knowledge of these risks.

Therefore, in consideration of these premises, the sufficiency of which we/I hereby acknowledge, we/I hereby release and hold harmless the Avon Grove School District, its agents and employees, from all claims, damages, or other liabilities for injuries to our/my son/daughter which are not the result of gross negligence, intentional neglect, or willful or wanton conduct by the Avon Gove School District, its agents and employees, related to our/my child's participation in the field trip. 

We/I understand by these terms that we are/I am releasing the Avon Grove School District, its agents and employees from liability, and our/my signature(s) to this permission slip constitutes acceptance of this limitation of liability.  

Our/my child understands and agrees to abide by all rules and regulations established by the school pertaining to such field trip. I also understand that if my child violates the school’s Code of Conduct and receives an In-School Suspension or Out-of-School suspension from the date this permission slip was distributed, Friday, November 14, 2008, to the day of the field trip, he or she will not be permitted to go on the trip. If my child is denied permission to attend the trip for this reason, an alternative in-school educational program will be offered that day. In addition, please note that any behavior that requires discipline on the field trip will preclude that student from attending the next field trip.

We/I consent to and give permission for emergency medical care for our/my child that may be needed as a result of our/my child’s participation:

Insurance: Group#: I.D.#:__________

______________________________ _____________

Student’s Signature Date

______________________________ _____________

Parent(s)/Guardian(s) Signature Date

______________________________ _____________

Parent(s)/Guardian(s) Signature Date

* Each student must return the signed permission form and payment before being permitted to participate in the field trip. The cost of the field trip will be $ 10.00 per student. Make checks payable to Fred S. Engle Middle School. Please write your child’s name on the check. Forms and money are due on Friday, December 5, 2008 by 7:50 A.M.