OFF-CAMPUS SCHOOL ACTIVITY
TO: Parent/Guardian
FROM: School
Principal
Your son/daughter is eligible to participate in a
school-sponsored activity requiring transportation to a location away from the
school building. This activity will take
place under the guidance and supervision of employees from
Name of Event:
FWBHS Band Activities
Destination: All Band Events
Designated Supervisor of Activity: Randy Folsom/Daniel Farr
Date: This
current school year
Method of Transportation: School and/or Commercial Buses
I hereby consent to participation by my child
_______________________________________________________ in the event described
above. I understand that this event will
take place away from the school grounds and that my child will be under the
supervision of the designated school employee on the stated dates. I further consent to the conditions stated
above on the participation in this event, including the method of
transportation.
If you would like your child to participate in this
event, please complete, sign and return the following statement of consent by
___________________.
As parent or legal guardian you remain fully
responsible for any legal responsibility which may result from any person
actions taken by the named student.
Signature of Parent or Guardian Date
PERMISSION FOR EMERGENCY
TREATMENT
On rare occasions an emergency requiring hospitalization, surgery, and/or other medical treatment develops. Since in some countries/states students under 21 years might not be administered an anesthetic or operated upon without the written consent of the parent/guardian, we request the parent/guardian to sign the following statement. This is to prevent a dangerous delay in case an emergency does occur and we are unable to contact the parents. The designated Supervisor of this activity will attempt to contact the parent/guardian prior to exercising the emergency treatment consent.
In the event of injury and/or illness to our
son/daughter __________________________________________ born
____________________
We hereby authorize a District representative who is
of the school campus of the District to obtain and give consent to whatsoever
medical treatment the representative deems necessary, including the
administration of an anesthetic and surgery, and do hereby release the District
and the representative from any and all claims which may arise from the
representative’s obtaining and consenting to said medical treatment.
Signature of Parent or Guardian
Telephone Number Date
Emergency Contact Person Telephone
Number
Comments:______________________________________________________________________________________________________________
STATE OF FLORIDA
COUNTY OF OKALOOSA
The foregoing instrument was acknowledged before me
this ________________________ By:
__________________________________
Date Name of Person Acknowledged
Who is personally known to me or who has produced
_____________________________________________________________
Type of
Identification
As identification and who did /
did not take an oath.
Signature of Person taking Acknowledgement
Signature of Notary