__________________________ (INSERT NAME AND ADDRESS OF SCHOOL), has organized the following field trip [INSERT DETAILS ABOUT FIELD TRIP. The undersigned parents/guardians of the student named below desire to have their child participate in the Field Trip and agree to the following:
1. There are certain risks of physical injury and other injuries and losses related to the Field Trip, and I assume the full risk of any injuries, damages or losses which the student may sustain as a result of participating in the Field Trip.
2. I fully waive, release and discharge the ______school name all claims from injuries (both personal and property) which the student may have or which may accrue related to the Field Trip and related activities.
3. By signing this form, the parent/guardian acknowledges that he or she has read and fully understands the contents of this form and executes it of his or her own free will and without any reservation whatsoever. If only one parent/guardian signs this document he or she acknowledges that his or her signature is on behalf of any other individual with parental or guardianship rights related to the student.
Field Trip Destination: _______________________
Date of Field Trip: _______________________
Trip Sponsor: _______________________
Student Cost: _______________________
Number of Teachers/Chaperones: _______________________
Time Leaving the Building: _______________________
Time returning to the building: _______________________
