Chancellor's Regulation A-670 (School Trips): Parent Notification/Consent Form

a) I understand that there are risks of injury associated with the above-listed physical and sports activities and I consent to my child’s participation in all these activities except for the following:

b) Please indicate below any permanent or temporary medical or other condition, including special dietary and medication needs, or the need for visual or auditory aids, which should be known about your child:c) I agree that in the event of an emergency injury or illness, the staff member(s) in charge of the trip may act on my behalf and at my expense in obtaining medical treatment for my child.

d) I understand that my child is expected to behave responsibly and to follow the school’s discipline code and policies.

e) I agree and understand that I am responsible for the actions of my child. I release the school from all claims and liability that arise in connection with the activity, except if due to the negligence of school officials.

g) I understand that alcoholic beverages and/or illegal drugs are prohibited and have discussed this prohibition with my child. I understand that if my child is found in possession of these substances, they will be subject to school disciplinary procedures and possible criminalprosecution.

h) I understand that students who violate the school’s discipline code may be excluded in the future by the school from participating in a event.

6th grade movie trip 4/11