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Submit a Field Trip Waiver

Field Trip Waiver

Submitter Information

Name of Form Submitter
Name of Form Submitter
First
Last
Select Your Field Trip

Field Trip Details

Location: Luv 2 Play - Chino (3983 Grand Ave, Chino, CA 91710)

Date: April 25, 2023

Time: 2:30 - 5:30 PM

Mode of Transportation: School Bus

Sack Lunch Needed: No

School Site: Montera

Participant(s)

Participant Name
Participant Name
First
Last
Select to Add Additional Participant
Additional Participant Name
Additional Participant Name
First
Last

Emergency Contact(s)

Emergency Contact Name
Emergency Contact Name
First
Last
Select to Add Additional Emergency Contact
Additional Emergency Contact Name
Additional Emergency Contact Name
First
Last

Allergies & Medication

All medication taken at school or on a field trip MUST be authorized by a doctor. The doctor forms are  available in the school health office. The medication MUST be brought to school in the original container,  properly labeled by the pharmacy, checked-in at the health office by a parent/guardian, and given with  signed consent using the district form. DO NOT WAIT UNTIL THE DAY BEFORE OR THE DAY OF THE  FIELD TRIP TO MAKE ARRANGEMENTS. 

Does your student have any allergic reactions, medical procedures, or any other necessary medications?
Do you have health insurance?

Consent Details

I understand that my child must abide by all the rules and regulations governing conduct as set forth by Student Hires LLC. I  understand that my child must fully cooperate with all Student Hires LLC employees and volunteer chaperones. My child's failure  to meet appropriate behavior standards may result in disciplinary action.  

I acknowledge that my participation in this field trip is voluntary. I further acknowledge that participation in this field  trip carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The  specific risks vary, but may involve minor injury, major injury, and serious injury, including permanent disability and  death, and severe social and economic losses which might result not only from my own actions, inactions, or  negligence, but the actions, inactions, or negligence of others, the rules of play, or the condition of the premises or of  any equipment used. I understand and appreciate these risks and knowingly assume all such risk.  

I understand that pursuant to California Education Code §35330, by participating in this field trip, I am deemed by law to have  waived all claims against the Student Hires LLC for injury, accident, illness or death occurring during or by reason  of the field trip. I therefore agree, to the maximum extent permitted by law, for myself, my family, my heirs, personal  representative(s), and/or assigns, to defend, hold harmless, indemnify and release, Student Hires LLC,  its Board members, administrators, officers, agents, and employees, from and against any and all claims, demands,  actions, or causes of action of any sort, present or future, on account of damage to personal property, or personal  injury, or illness, or death which may result from my participation in this field trip.  

In the event of any illness or injury, I give full authority to the District to obtain such medical treatment and/or surgery  from a licensed physician/surgeon, paramedic, or hospital as deemed necessary for the welfare of my child. 

Consent Agreement *

Thank you for supporting Student Hires.

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