Parent Permission Form for Field Trip Participation
Dear Parent or Legal Guardian:
Your son/daughter is eligible to participate in a school/parish-sponsored activity requiring transportation to a location away from the school premises. This activity will take place under the guidance and supervision of employees from Our Lady of Refuge School and/or/ Parish.
Name of Event:  Upland Hills Farm
     Destination:  Oxford, Michigan
Designated Supervisor: Mrs. Taptich / Ms. Kopilchack
Date / Time of Departure: Thursday, October 2, 2003
Method of Transportation:  Bus
Student Cost: $11.50
Parent / Chaperone Cost: $7.00


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/parish grounds and that my child will be under the supervision of the designated school/parish employee on the stated dates. I further consent to the conditions stated above on participation in this event, including the method of transportation.

In consideration of my child being allow to participate in this field trip, I hereby agree on behalf of myself and my child, to release Our Lady of Refuge School and/or Parish, the Roman Catholic (Arch)diocese of Detroit, and any and all affiliated organizations, their employees, agents and representatives, including volunteer drivers (collectively "Releasees"), from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child's participation in the field trip. In the event this release on behalf of myself and/or my child is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releasees from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child's participation in the field trip. This release of indemnification does not apply to claims for intentional misconduct or gross negligence; nor does this release or indemnification apply to the extent of commercial insurance coverage for any claim, but this Release or Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim.

 

 

                                   


                    (Print Parent's Name)

 


 (Date)

 


                    (Parent's Signature)
 
Please return this entire form by:   9/12/03     to     Mrs. Taptich/ Ms. Kopilchack (Supervisors)


 Sept. 2003
 
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