• UPWARD BOUND FIELD TRIP

    Authorization for Student Participation
  • THIS FORM COVERS ALL FIELD TRIPS FROM 

    September 1, 2020 - August 31, 2021

    ** Parents, please complete all of the following information**

  • A. Parent/Guardian Information

    I understand that my son/daughter is not required to attend this ESC Region 12 field trip. I give permission for participation in the activity. I agree to release Education Service Center Region 12 and its officials, officers, and employees from liability for any and all claims of injury which might occur while my son/daughter is participating in this field trip activity.

    B. Emergency Medical Authorization

    Should a medical emergency arise while my son/daughter is participating in this activity, I will be notified at the above number in order to approve medical treatment. In the event that I or one of the emergency contacts listed below cannot be reached, I give permission for immediate treatment as required in the judgment of the attending physician. I understand and agree that I will be responsible for the cost of such treatment.

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