FIELD TRIP CONSENT FORM,
RELEASE
FROM LIABILITY AND INDEMNITY
AGREEMENT
I/We, the undersigned parent(s) or guardian(s) of
______________________________, a
minor, do hereby CONSENT to
his/her participation in the Art 2,3,4
educational field trip to the
Brandeis University: 3D Maker lab, Rose
Art gallery planned for April 29, 2015,
and sponsored by the Weston Public Schools. Students will be missing Part of
A(10am on bus), H,G, E block on day 2. Please bring ___$8____ dollars for bus
and $ money for lunch at cafeteria or you can bring your own lunch.
I/We forever RELEASE and
discharge the Town of Weston and its departments, officers, employees, and
agents (hereinafter collectively referred to as “Weston”), from any and all
claims, damages, losses or expenses of whatever kind or nature which I/we may
have or acquired as the parent(s) or guardian(s) of said minor arising out of
or resulting, directly or indirectly, from said minor’s participation in this
field trip. I/We also RELEASE and
discharge Weston from any and all claims, damages, losses or expenses of
whatever kind or nature which said minor may have or acquire arising out of or
resulting from, directly or indirectly, his/her participation in this field
trip.
I/We furthermore agree to
defend and INDEMNIFY against any claims, damage, loss or expense of whatever
kind or nature that Weston may have to pay that arises from said minor’s
intentional, grossly negligent, or reckless acts or omissions while
participating in this field trip.
I/We further authorize Weston’s employee(s) or agent(s)
who is supervising said minor while participating in this field trip to require
said minor to comply with any rules, standards of behavior or instructions such
employee(s) or agent(s) may reasonably establish including those outlined in
the Weston High School Student/Parent Handbook.
I/We hereby authorize Weston employee(s) or agent(s) who
is supervising said minor, and/or the host family of said minor (if applicable)
to act on our behalf in authorizing and consenting to emergency medical care,
dental care, and/or hospitalization for said minor if he/she becomes ill or is
injured while participating on the field trip.
This Authorization and Consent may be presented to the appropriate
medical/dental staff at such time as emergency medical care, dental care or
hospitalization is required. I/We hereby
RELEASE and discharge Weston from any and all claims of any nature whatsoever,
which may arise out of the decision to provide emergency medical care, dental
care or hospitalization during this field trip.
I/We give permission for
delegated school personnel to administer required prescribed medication during
the field trip.
Signature of Parent or
Guardian Date Relationship
Please list any allergies, required medications or limitations________________________
______________________________________________________________________________________
Emergency Telephone Number(s)
___________________________________________
_________________________________________________________________
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