Field Trip InfoPosted by Ryan Hanna on 10/8/2019 1:00:00 AM
Beverly Hills Middle School Field Trip Permission & Medical Release Form
STUDENT’S NAME: ________________________________ HOMEROOM: ____________
Trip to: THE PHILADELPHIA ZOO on: THURSDAY, NOVEMBER 7, 2019. We will be leaving BH at 9:00 AM and returning at 2:00 PM Cost: $ 5.00
COST ($5) & PERMISSION SLIP DUE BY THURSDAY, OCTOBER 24, 2019.
CONDUCT - While on field trips students are expected to display the following:
~ Respect for all rules + regulations ~ Cooperation with those in authority ~ Care for the safety
of self and others ~ Respectful attention to instructions, information, presentations.
RELEASE- By signing this release I agree to release + hold harmless Beverly Hills Middle School (BHMS), Upper Darby School District (UDSD), its agents, employees, officers, sponsors of this trip and chaperones from any and all liability, loss, damages, claims, or actions for bodily injury and/or property damage, in accordance with current state and federal law, arising out of participation in this trip. I further acknowledge that this release is binding upon my heirs, successors or assigns.
CURRENT EMERGENCY CONTACT INFORMATION
Home Telephone Number_____________________________________________________________________
Parent/Guardian Cell Phone Number_____________________________________________________________
Parent/Guardian Employment or Emergency Phone Number __________________________________________
AUTHORITY TO ACT FOR THE DELIVERY OF EMERGENCY MEDICAL CARE
If any emergency medical procedure or treatment is required by the student during the field trip, I consent to the agent(s) of the school arranging for or consenting to the procedures or treatments at his/her discretion.
IMPORTANT MEDICAL INFORMATION Medication taken on field trips must follow the UDSD medication policy requiring written physician’s orders and written parent/guardian request as stated in the manual. I understand that if my child has a medical condition and I do not provide the required medication, then BHMS + UDSD will not be held responsible in the event of a medical incident. BHMS reserves the right to refuse field trip participation to any student who does not provide critical emergency medications if those medications are deemed medically necessary. BHMS agents reserve the right to initiate the 911 Emergency Medical System if necessary.
Relevant Medical Information: ___________________________________________________
PERMISSION TO ATTEND FIELD TRIP ~ I give permission for my child to participate in this field trip. I have read the above and expect my child to abide by all rules and regulations set forth by the school.
Parent/Guardian Signature ________________________________Date __________________
Student Signature _______________________________________Date __________________