SAN ANTONIO INDEPENDENT. \CHOOL DISTRICT c SAISD FIELD TRIP PERMISSION SSION FOR ACKNOWLEDGMENT OF RESPONSIBILITY AND PERMI STUDENT PARTICIPATION IN FIELD TRIP OR OUT-OF-SCHOOL ACTIVITY, (parent/guardian), vgtee Wo allow my won or daughter, (Gtudent’s name), to attend the following field trip oF DestinatiowDetailed Description Of Activity and Kdueational Purpose (e complet inerary ofthe field pacity shal be included with his parent “ue TS Hed COW , ECD NAlley, ‘Date of fied wipractiviy | VAGHUTERY C8 ie Finan ACB, BIW Group/Class/Schoo! Club: ANS . Yabo WAY oe = Sponor ofthe fel tic: Paceraap eos eos ae ES roma Vehicle) Leased Vehicle ‘of-schoo! activity. ‘School Bus C] CommercialCharter Bus as a None (provide your own or none needed) Drivers of Private or Leased Vehicles (Check all hat apply.) Cy Teacher or Staff Member [] Pareat [J Student [) Other Adult For a trip returning to school after the end ofthe school day, my son/daughter will (check one]: C1 be picked up by me or another adult Drie the bus home O walk home other arangement: — Health Services Will your child require the administration of any medication or medical procedure while onthe fied C iw O ves Bo tyes please indicate the mediation(s) and/or procedures) wit times for adi Medication/Procedure ‘Student Agreement ‘While participating on this field trp, I will accept responsibility for maintaining good conduct and appearance, and I will follow directions at all ‘Student's Signature: Date ‘This isto certify that I authorize the Superintendent ora designated representative to secure any and all emergency medical care and treatment for ‘my child for acute illness suffered or injury sustained while participating inthis trip or activity. 1 understand that, while student safety i a high priority forthe District, under State law, the school is not responsible for medical costs associated with student injury. {In consideration for my childs participation in the above escribed fied trip or activity, expressly hold harmless from and waive against the District, its Trustees, employees, agens, and assigns, any and al claims for medical expenses, los of services, injury to person or property, death, or other claims, actions, or liabilities made agains itor them on behalf of my child, regardless of the cause of such claims, actions, or liabilities oF any concurrent or contributing fault or negligence of it or them as such may result from my child's participation inthe trip or activity. In further consideration for my child's participation in the above-described field trip or activity, I also agree to indemnify and hold harmless the District, its Trustees, employees, agents, and assign, from and against any and all suits, actions, losses, damages, claims, or liabilities of any character, type, or description, including attorney's fees and court costs, made by third partes against itor them which may result from my child's participation inthe trip or activity. l understand thatthe District, its Trustees, employees, and agents are not waiving any sovere governmental immunity, which itor they have under Texas law. Ihave read and understand this release and sign it voluntarily a knowledge ofits significance. Signature of Parent/Guardian: ate: Daytime phone: Emergency contat Phone: awe | [Notice to Paes” ikere any activi lated onthe itinerary ofthe fled rip Tact that you do wat wth or your cit parelpae a plete nol the schoo! sa. You may lat th actviy on th hack of ths parent prmision form. € ‘Sheen near Kol Dc does ot drat on kr bn af cea coal wg, pr, aby pin hon evi wan, al opm ag ‘eel papa cern wid THe Vibe Cr Rigs Ato 194 mended Tae XE! Aneesh Rabin ao 1, ome Revised September 2010 FORMED-A