VOLUNTARY EXCURSION/FIELD TRIP NOTICE AND MEDICAL AUTHORIZATION – MINOR
Medical Release: In the event of illness or injury, I do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgement of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.
As stated in California Education Code Section 35330, I understand that I waive all claims against the Tehama County Department of Education, its officers, agents and employees for any injury, accident, illness, or death occurring during or by reason of this field trip or excursion, including acts of negligence by the Tehama County Department of Education, its officers, agents or employees.
Mandated Reporting Release: Most information shared between participants and Program Representatives is secured and completely confidential. Please be aware that a few exceptions will apply when/if information is shared regarding abuse (physical, mental, or sexual) and/or harm to oneself or others must be report by law to the appropriate individuals.
The California Child Abuse and Neglect Reporting ACT (CANRA) can be found in California Penal Code Sections 11164 - 11174.3. Under CANRA, mandatory reports are legally mandated to report the list below, is not limited but includes the following individuals who must report abuse or neglect: Clergy Members and custodian of records for clergy members; Child Care Providers; Educator or any local district, county, or state education employees, Law Enforcement; Medical Providers; Mental Health Professionals; and Commercial Film and Photographic Print Processors.
Permission to Access School Records: I hereby give TCDE/BCC Program staff permission to have access to grades, progress reports, school transcripts, and updated contact information from the school administration. I authorize TCDE/BCC to assist with my child’s college admission, financial aid application (FAFSA), acceptance status, and award letter(s) to any and all colleges/universities they choose to apply to after they graduate from high school.
Participation: I give my permission for my child to participate in TCDE/BCC (TS) activities; I agree to encourage my child to do well in middle and high school, as well as pursue post-secondary education based on their career interests. Lack of participation and/or non-attendance at any group or individual meetings for TS may result in the student being dropped from the TS program for the academic year or remaining academic year, as noticed by the site Program Specialist of lack or non-attendance from students. Please have students notify the site Program Specialist or the BCC office know if you are
moving out of the service or school site area boundaries.
I fully understand that participants are to abide by all rules and regulations governing conduct during the trip. Any violation of these rules and regulations may result in that individual being sent home at the expense of his/her parent/guardian.