Field Trip Permission Form Release, Indemnification & Waiver Of Liability printable pdf download

FIELD TRIP PERMISSION FORM

RELEASE, INDEMNIFICATION & WAIVER OF LIABILITY

Date: __________________

Dear ______________________________,

(Faculty Member in Charge)

I, ________________________________________, am the ____________________________________

(Name of Parent/Guardian)

(Father, Mother, Custodial Parent, Legal Guardian)

of ________________________________________, a student at _______________________________

(Name of Student)

(Name of School)

in the ______ Grade.

I hereby grant permission for the above-named child to attend ___________________________________

(Description/Destination of Field Trip)

on _______________________________ from ___________ to ___________ and I consent to the child’s

(Date of Field Trip)

Time

participation in such a field trip.

I understand that the child will be transported to the place of the field trip by ______________________.

(Means of Transportation)

I understand that all activities have certain risks and could result in injury to the above child. In

consideration of the above child being permitted to participate in the above field trip, on behalf of the

child and on behalf of the mother, father, next of kin and (if applicable) the guardian of the above child, I

hereby assume all risk of injury which may be sustained by the child in connection with the above field

trip.

further

specifically

waive,

release

and

discharge

the

Diocese

Cleveland,

_________________________________, _______________________________, and the employees and

(Name of School)

(Name of Parish)

volunteers of the aforesaid school, parish, and/or diocese from all claims arising out of and/or resulting

from harm, bodily injury, loss of life or property, damages and losses sustained by the child while

participating in the above field trip, including claims of the child’s parents and/or next of kin and/or (if

applicable) guardian. I further agree to indemnify the Diocese of Cleveland, _______________________

(Name of School)

________________________________,

and the employees/volunteers of the aforesaid school, parish,

(Name of Parish)

Diocese and/or their employees/volunteers as a result of injury or damage suffered by the above child

and/or the child’s parents and/or next of kin and/or (if applicable) guardian, arising out of the child’s

participation in the field trip. Furthermore, I acknowledge that it is my responsibility to provide adequate

health insurance for the above child.

I fully understand what is involved in the field trip and I understand that I have the opportunity to contact

the teacher and ask him/her about the field trip.

I have read and fully understand the contents of this entire document and consent to the

provisions contained therein.

________________________________

(Parent/Guardian Signature)

Revised July, 2010

Field Trip Permission Form Release, Indemnification & Waiver Of Liability

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