SAMPLE
XYZ Charter
719
555/555-1234
I, _____________________________, the parent of ______________________________ do
Parent Name Child Name
hereby
give my permission to XYZ Charter to take
___________________________on field
Child Name
trips during school hours throughout the ______________school
year.
I, _____________________________, the parent of ______________________________ do
Parent Name Child Name
hereby
hold XYZ Charter harmless for any claims that might arise out of incident while
transporting students of XYZ Charter on field trips in personal (privately
owned) vehicles.
The parent understands
that participation is purely voluntary and assumes the risk of any injury
resulting from or connected to that participation in the trip will not be the
responsibility of XYZ Charter. The
parent hereby agrees to indemnify, defend and hold harmless XYZ Charter of it
trustees, officers, employees and agents against any and all liabilities,
losses, damages, claims, actions, or expenses, including reasonable attorney’s
fees arising out of any and all claims, demands, causes of action and suits of
whatever nature, in law or equity, that arise out of or are connected with, or
are based in whole or in part of any conduct, fact, matter, act or mission that
relates to or is otherwise connected with transportation to the activity
described above.
In the event that you plan on
using your vehicle for school functions, you must provide a copy of your
insurance card and a copy of your driver’s license. Please complete the volunteer driver form if
you intend to drive. You will need to
notify XYZ Charter if your insurance is terminated or cancelled. Thank you.
__________________________________________ _______________________________
Parent Signature Date
III. 46