Cal Poly Pomona University by opn1mPE

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									                                    Cal Poly Pomona University
                                         Children’s Center
                                  3801 W. Temple Ave., Bldg. 116
                                     Pomona, CA 91768-2557



              AUTHORIZATION FOR KID’S UNIVERSITY FIELD TRIPS

I, _______________________, the parent having legal custody or the legal guardianship of
______________________ (child), hereby authorize the Cal Poly Pomona Children’s Center to
take my child on the following types of field trips during his/her enrollment at the Center, as
indicated below:


   1. Walking Trips
      [I DO] or [DO NOT] (circle one)
      Authorize my child to participate in short walking trips on the California Polytechnic
      State Pomona University Campus.

   2. Car/Van Trips
       I [DO] or [DO NOT] (circle one)
      Authorize my child to participate in short trips to destinations on the California
      Polytechnic State, Pomona University campus by car or van. I understand that seat belts
      will be available for and used by my child, and that I will provide a car seat for my child
      if he/she is under sixty pounds.
      ____ (Initial here)



       I hereby acknowledge that I have read and signed the attached Release of Liability,
       Waiver, and Assumptions of Risk Agreement, which is incorporated herein by reference
       as if set out in full, I further hereby acknowledge that the terms of the Release of
       Liability, Waiver, and Assumption Risk Agreement shall apply and all field trips in
       which my child participates as a result of my authorization.



       Date: __________________                      ___________________________________
                                                            Signature of Parent/Legal Guardian

       Date: __________________                      ___________________________________
                                                            Signature of Parent/Legal Guardian

								
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