AUBURN CITY SCHOOLSTRIP PERMISSION FORM

t ,Mother/Father/Guardian (Circle One)

hereby grant permission for my chi ld,

to go on the tr ip to Auburn High School Seussical the Musical

T'ME AND DATE oF DE'ARTURE. 8 :1Sam April22,2014(Time) ,

ESTIMATED TIEM AND DATE OF RETURN: 12:OOPM(Date)

Npril22,2014

METH'D oF TRANS' 'RTATT.N Bus (Time) (Date)

TEACHER oR .LASS Cary Woods Elementary

cosr ro sruDENT (tF ANY) 5 2'00

In granting this permission I hereby expressly waive my claim for l iabil i ty against Auburn City Schools, the Board ofEducation, including its employees and representatives, and release them from all l iabil i ty in connection with thist r ip ,

Further, I assume full responsibil i ty for any damage to persons or property caused by my child or ward, I furtherexpressly agree that in the event disciplinary action may be necessary, my child or ward may be forthwith returnedhome at my expense.

Further, in case of injury or emergency to my child or ward, I hereby authorize the school to act in the best interestof my child, I further consent and wil l be responsible for any medical or dental treatment that may be advisable atthe discretion of any physician or dentist. I understand that I wil l be personally notif ied if i t becomes necessary formy child or ward to be returned home and/or require health treatment.

It is further warranted that if this CONSENT FORM is signed by one or two parents or guardians, it is with theauthority ofthe other,

*THE COST OF THE FIELD TRIP IS NON-REFUNDABI.E

Signature of Parent or Guardian Date

My chi ld, wi l l have a

[ ] school lunch[ ] home lunch on this day

Parent 's Signature

Please return by