Trip Waiver Form | Don Bosco Prep

Trip Information- ADMIN ONLY

Details of the trip are below.

Location/Name*

Location Address

Street Address City State ZIP Code

Moderator

First Last

Departure Date

Departure Time

:

Return Date*

Return Time*

:

Student Information

Name*

First Last

Grade*

Address*

Street Address City State ZIP Code

Emergency Phone*

Parent/Guardian Information

Name*

First Last

Email*

Don Bosco Prep Trip Waiver Form

I/we the parent(s) of student/athlete list above request that my son attend the Don Bosco Prep sponsored trip: “Information located above” I also authorize the trip moderator: located above to take participants to medical facilities for treatment in the event of sickness or injury, and act as their guardian for the limited purpose of making any medical care or treatment decisions if the parents or guardians cannot be reached immediately by phone.

Since this is a school-sponsored trip, we remind all participants and their parents that all school policies and regulations are to be observed. No Drinking or Drugs! Alcoholic beverages and/or drugs (including any controlled dangerous substances) are forbidden. Smoking is against school policy and as such is not allowed. Violation of any school rule will result in penalties and may include immediate removal from the trip.

A student who must be sent home due to a serious disciplinary infraction of Don Bosco Prep school policy may be sent home unattended and at the parent’s/guardian’s expense and responsibility.

The undersigned also acknowledges that Don Bosco Prep is not liable for any lost or misplaced items. Participants are reminded to always keep valuables in a safe place.

Transportation will be bus departing at Time and Date located above and returning at Time and Date located above. All trips will depart from and return to Don Bosco Prep High School. It is against school policy for trip moderators or chaperons to pick up a participant from his/her home or drop him/her off once the trip is over. (It is also against school policy for an overnight trip to take place without a parent chaperone.)

Acknowledgement*

In consideration for my child's participation, I (the undersigned) agree to indemnify Don Bosco Prep, the trip moderator(s), and the chaperons for any injury, loss, or damage to person(s) or property resulting from my son’s/daughter’s actions on the trip. I have read and hereby agree to all items stated on this permission slip and assume full responsibility for the actions of my son(s)/daughter(s).

Medical Permission Form

The undersigned parent or guardian hereby gives permission for the trip moderator(s) or chaperone(s) to authorize emergency medical treatment as may be deemed necessary for the student named below, while participating in a trip sponsored by Don Bosco Preparatory High School on the dates stipulated on the DBP Trip Waiver Form.

Emergency Contact Name*

First Last

Phone*

Medical Insurance Company*

Policy #*

Parent/Guardian Signature

I acknowledge that my son is responsible for his own transportation to and from CT on 12/14-12/15 except team transport from hotel to the Ice rink on Sunday

Date

Parent/Guardian Signature*