Parental Consent - Child Trip Permission

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Parental Consent - Child Trip Permission Powered By Docstoc
					This form is executed by the natural parents or legal guardian of a minor child granting
permission for the minor child to participate in and attend a certain trip. The form also
grants permission for medical and dental treatment to be sought in the event of an
emergency. This template form can be modified by a parent or guardian to include
specific instructions regarding their child that will be participating in a planned trip.
                                 TRIP PERMISSION

        I _____________________[NAME OF PARENT], THE NATURAL PARENT/LEGAL
GUARDIAN [SPECIFY WHICH LEGAL RELATIONSHIP] of __________________
[PROVIDE FULL LEGAL NAME, AND NAME THE CHILD IS KNOWN BY (IF
DIFFERENT FROM THE LEGAL NAME)], hereby grant my permission for my child to
attend the trip to ___________________________[BRIEFLY DESCRIBE LOCATION(S)
OF THIS FIELD TRIP], which is to be held on or about the _____ day of ________________,
201____ , during the approximate hours of _________ to __________.

       I ACKNOWLEDGE that there may be risks associated with such trip and I hereby
authorize my child to participate in all activities associated with the said trip.

       IN THE EVENT my child suffers an injury while on the said trip that requires medical or
dental attention or treatment, I hereby authorize _________________ [PROVIDE NAME OF
SCHOOL OR OTHER ADULT/OFFICIAL WHO WILL HAVE THIS AUTHORITY] to
take my child to the required medical or dental facility for treatment and to authorize treatment
for my child in my absence.

       In the event of an emergency, I can be contacted at the following: ________________
___________________________________________________________________________
{Instruction: Provide any and all contact information. E.g., email, home and cell and work
phone numbers, etc.}

       My child has the following allergies to food or other things: ______________________

       My child has the following health and/or medical conditions: _____________________

{Instruction: Provide details above, if applicable. Write in "None" or "Not Applicable" or
"N/A" in either or both spaces, if no allergies and/or no health concerns.}

       EXECUTED this ____ day of _______________, 201_____.




Witness:                                            Parent’s                           Signature

				
DOCUMENT INFO
Description: This form is executed by the natural parents or legal guardian of a minor child granting permission for the minor child to participate in and attend a certain trip. The form also grants permission for medical and dental treatment to be sought in the event of an emergency. This template form can be modified by a parent or guardian to include specific instructions regarding their child that will be participating in a planned trip.
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