Permission for Student Travel - Madison Public Schools

Parent/Guardian Permission and Acknowledgement of Risk for Student Travel

Parent Directions: Please read and submit this form if you give your child permission to attend the school trip.

Student's Namerequired

First Name

Last Name

Principal:

Date of Trip

Must contain a date in M/D/YYYY format

Trip Organizer

Destination of Trip

Cost of Trip

Educational Objectives

SUPERVISION

A School Nurse will be present on this school trip.

Students will be directly supervised by adults at all times

Students will be directly supervised by adults with the following exceptions

Exceptions

DRIVERS OF PERSONAL OR LEASED VEHICLES (Grades 4-12)

Parent

Teacher / Staff Member

Other Adult

STUDENT AGREEMENT

While participating in this school trip, I will accept responsibility for maintaining conduct in accordance with the Madison Public School's Code of Conduct and I will follow directions of the school trip organizers/chaperones at all times.

Student:required

Name of Grade 4-12 Student agreeing to terms above

Date

Must contain a date in M/D/YYYY format

PARENT/GUARDIAN ACKNOWLEDGEMENT OF RISKS

I understand that participation in this school trip is voluntary and exposes my child to risks. I also understand that the trip may include amusement/theme park activities and that participation in amusement/theme park activities will expose my child to some risk of injury or even death. I have read and understand the attached description of the school trip. I also understand that participation in the school trip will involve activities off school property; therefore, neither the Board of Education nor its employees and volunteers will have any responsibility for the condition or use of any nonschool property.

PARENT/GUARDIAN PERMISSIONrequired

I give permission for the student named above to participate in all aspects of this school trip.

Date

Must contain a date in M/D/YYYY format

The Madison Public Schools cannot be responsible for reimbursements to parents or students of money submitted as "advance payment" (e.g. Broadway shows, transportation, hotels) for any field trip that the district cancels.