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Libby Middle School FIELD TRIPS / PARENT PERMISSION

Registration Deadline 08/30/2018
Payment Deadline 06/12/2019


Sections
Participant Information
Agreements

For each of the agreements below, please read the terms, check the box to mark your acknowledgement, and type your name to confirm.

Warranty of Parent/Guardian

Under the pains and penalties of perjury, by submitting this registration form, I represent and warrant that I am (i) the parent or guardian listed above; (ii) at least 18 years old, and (iii) fully able and competent to enter into this agreement.

Emergency Medical Treatment

In the event of serious injury and your family doctor cannot be contacted and we are unable to contact one or the other parent, the staff member/advisor has your

permission to seek medical attention from the nearest physician.

Student Code of Conduct Agreement (requires signature)

Student Code of Conduct Agreement (requires signature)

My student, of the Richland School District, understands that while on the above named field trip, I am under the direction and authority of the advisor in charge, as representative of the Richland School District.

I understand that I am expected to be with the group at all times and will abide by this expectation.

I will be respectful to, and follow the instructions of, the adult supervisors traveling with the group.

I also understand that the following behaviors are prohibited:

- Possession and/or use of alcoholic beverages, illegal drugs and tobacco.

- Possession and/or use of any kind of weapon (including pocketknives) or fireworks.

- Use of foul and/or abusive language or lewd behavior.

I understand further that failure to follow these guidelines will jeopardize my privilege to continue on the trip. I also understand that, in the event that I have not met the guidelines stated in the Code of Conduct, the supervisors retain the option of sending me home early at the expense of my parents/guardians.

I have read, reviewed with my child and agree with the above Code of Conduct. (See attached Parent/Guardian Permission Form.)

Field Trip Permission Slip

Activity/Trip Parent/Guardian Permission Form (requires signature)

I understand that the school district will make every reasonable effort to provide a safe environment, I am fully aware of the special dangers and risks inherent in participating In the activity, which may include physical injury or other consequences arising or resulting from the activity.

Being fully informed as to these risks, I hereby consent to my student participating in the field/activity trip mentioned above.

In the event of an accident or illness, I understand that every reasonable effort will be made to contact the parent/guardian immediately. However, if I am not available I authorize the school district to secure the emergency medical care as needed. I authorize the above named advisor(s) to secure the services of a physician or hospital, and to incur the expenses for necessary services in the event of an accident or illness, and I will provide for the payment of these costs.

On behalf of the above-named student, I hereby absolve and release the school officials from any claims for personal injuries which might be sustained while he/she is en-route to and from or during the activity/trip.

We agree to abide by the activity/trip Code of Conduct Guidelines. Should a conduct code violation occur the advisor(s) have the option to send home the student at the parent's expense. Reasonable care shall be exercised to insure the safest and most expedient and financially feasible mode of transportation back to the home community of the student. I am aware of the consequences that will result from violation of any of the Code of Conduct Guidelines.

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Payment Method
$5.00

Cost is $5.00 Please pay at Book Keeping Office