Dear Parent/Guardian:
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
teachers and other representatives of Saint Joseph School.
A brief description of the activity is as follows:
Event:
_______________________________________________________________
Destination:
______________________________________________________________
Designated
Supervisor: _____________________________________________________
Date
and Time of Departure: ________________________________________________
Date
and Anticipated Time of Return:
_________________________________________
Method
of Transportation: __________________________________________________
Student
Cost: ____________________________________________________________
If
you would like your child to participate in this event, please complete, sign
and return the following statement of consent and release of liability.
As parent/guardian, you remain fully responsible for any legal liability
which may result from any personal actions taken by your student.
If you have any updated information relating to your child or his/her
participation in this event, please advise the School as soon as possible.
***************************************************
I
request that my child participate in this event.
I understand that this event will take place away
from
school grounds and that my child will be under supervision of the supervisor
named above. I consent to the
conditions of the event stated above, including the method of transportation.
I
understand and agree that in the event that my child should suffer injury of any
sort while participating in this even, I will not seek to pursue any claims
against the supervisor named above, the School, and/or any of its agents,
servants, employees or volunteers, unless such injury is caused solely by the
intentional or grossly negligent conduct of the named supervisor.
______________________________________________
(Signature
of Parent/Guardian)
______________________________________________
(Signature
of Parent/Guardian)
Please return this entire form to the School by
______________________________________