Excel Academy Permissions Slip and Authorization Form

Name of Field Trip*

Date of Field Trip*

Date

Name of Parent Attending Field Trip*

First NameLast Name

Parent Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Family Teacher of Record (ToR)*

Special Accommodations: Please list any allergies/medical conditions.

I, a parent/guardian of an Excel Academy Charter School (“Charter School”) student, hereby acknowledge my intent to attend the above-described field trip as a parent/guardian participant. I acknowledge that I am required to supervise my student at all times during the field trip and to secure transportation for my student to and from the field trip.

As a parent/guardian participant, I acknowledge that I shall adhere to any applicable Charter School policies and procedures, and that I will follow all direction and guidance of the Charter School employee(s) who are responsible for the field trip.

As a parent/guardian participant, I acknowledge that I shall be responsible for any and all fees/costs associated with my participation in the field trip, unless otherwise notified in advance by the Charter School.

I understand that in determining that participation in this field trip has educational value, the Charter School has not investigated or approved its safety, the qualifications or financial responsibility of any person or firm involved in the field trip, or the facilities or equipment that may be used.

In addition, I acknowledge the Charter School shall not provide or approve transportation to or from this field trip. All participants are expected to secure their own transportation to and from the field trip destination.

I hereby waive, release and discharge the Charter School, its employees and agents, and the State of California from any and all claims for damages or personal injury, accident, illness, death, or property damage occurring during or by reason of the field trip. I acknowledge and understand that the field trip may involve an element of risk and/or danger of accidents and knowing those risks, I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns.

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS RELEASE OF LIABILITY IS A CONTRACT BETWEEN MYSELF AND THE CHARTER SCHOOL. My signature below acknowledges my participation in this field trip and voluntary agreement to the foregoing terms.

By signing my name below, I hereby acknowledge my intent to sign this Field Trip Parent/Guardian Participation and Release of Liability, and affirm all of the above.

Parent Signature*