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Permission Slip

VIEWS: 5 PAGES: 2

									                    EDMOND PUBLIC SCHOOLS
                                  Empowering all students to succeed in a changing society


                                          Edmond Public Schools
                                  Student/Parent Permission to Participate
                                          In-State School Activity


The Student/Parent Permission to Participate form must be completed in order for the student to
participate in the school activity conducted within the state of Oklahoma.

        I, ________________________________ (print student's name) (referred to as “Student”), desire to
participate in the following school activity:

Type of Activity:               TSA Competition in Tulsa
Date of Activity:             Saturday, February 25, 2012
        Dress – gray pants, black shoes & socks, white button shirt, blazer & tie (provided)
        Be at Summit 6:45 a.m.
        Bring SUPPLIES!!!
        Lunch is included in registration
        Return to Summit approximately 6:00 p.m.

        As the parent/guardian of the above named student, I___________________________ (print name) desire
for my child to participate in such school activity. In signing this agreement below, I (We) agree to the following:

        (1) Student will abide by all rules and regulations of the student’s school and Edmond Public Schools
which apply to the School Activity. Student will obey all instructions and directives given to Student by adults
providing supervision for the trip.

         (2) Students are not authorized to operate any motor vehicle while on the school activity. Motor vehicle
includes any motorized transport of two or more wheels. An exception to this policy will be considered for a
student with a valid driver’s license if special circumstances dictate that he/she must travel to the school activity
in his/her personal vehicle. The travel arrangements shall be limited to the Oklahoma City metropolitan area. The
student must have the permission of the parent AND the school administration in order to travel in his/her
personal vehicle.

         (3) Student and parent/guardian also understand that the consequences for Student violating this
agreement above could mean that Student would be sent home. Depending on the seriousness of the offense,
Student could be sent home without warning, such as if there were a violation of the drinking, driving, or drugs
rules. If Student is sent home for violation of this agreement, both Student and parent/guardian agree that Student
will be sent home at Student’s and parent's/guardian’s expense.




Revised: September 13, 2010
                    EDMOND PUBLIC SCHOOLS
                                     Empowering all students to succeed in a changing society


                                           Parent Permission to Participate

        The parent/guardian signing below hereby grants permission for the student to participate in the School
Activity. Both parent/guardian and Student have read this agreement, voluntarily sign below, and agree to be
bound by the terms and conditions of this agreement.

___________________________________                       __________________________________________
Student's Signature                                             Parent/Legal Guardian's Signature
                                                               (For students under 18 years old)
___________________________________
(Print Student's Name)

Dated: _________________

                                             Important Contact Information



Parent Name (Print):    _________________________________

Phone Number (Home) ________________________ Work or Cell Phone: _________________________


In the event of illness or accident, if we should need to contact someone other than listed above, please contact:
__________________________________________________________________________

                                                Consent to Medical Care

       If your child sustains a non life-threatening injury, Oklahoma law requires that a hospital
have parental consent before beginning treatment. This form allows you to give the necessary
permission, even if your child is under the care of another adult. With your consent, this form can
be presented at any medical office, clinic, or hospital in Oklahoma for emergency medical care.

        In the event of illness or injury, Student and parent/guardian hereby consent to whatever
x-ray, examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital
care from a licensed physician as deemed necessary for the safety and welfare of Student. It is
understood that the resulting expenses will be the responsibility of the student participant and/or
parent or guardian.


_____________________________________________________________________________
(Parent or guardian signature regarding Consent to Medical Care only)




Revised: September 13, 2010

								
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