Field Trip Permission Form

I hereby give permission for the below named student to go on field trips associated with the Leadership Franklin County Youth program during the 2018 – 2019 school year and for the May 2018 Orientation with transportation services provided by Rolling Hills Transit (formerly Manito Transportation Services) and in some cases contract busing providers.

All possible care and precaution will be taken to safeguard your student from accident or injury. In the event the above-named student is hurt or injured during these trips or during the summer retreat session, the Leadership Franklin County Youth program will not be responsible to pay any prescriptions, doctor, or hospital bills, or any sum of damages to the student, or the student’s parents.

In the event your child becomes ill and may require medical treatment, the following will apply:

A. Permission is granted for the above-named child to receive medical treatment at the nearest hospital.

B. The staff is allowed to release medical information pertinent to the above-named child.

All field trips associated with LFCY will occur during the school day from 8am-2pm throughout the 2018 – 2019 school year in addition to the May 2018 Orientation session. All trips will be supervised by Leadership Franklin County Youth program coordinator.

STUDENTS ARE NOT PERMITTED TO DRIVE – MUST RIDE BUS

* 1. Student Name

* 2. List any medical problems:

* 3. We carry medical insurance with:

* 4. Student Signature: By typing my name below, I acknowledge that I agree to and understand the conditions stated above in the field trip permission form.

* 5. Parent or Guardian Signature: By typing my name below, I acknowledge that I agree to and understand the conditions stated above in the field trip permission form.

* 6. Home Phone #

* 7. Work Phone #

* 8. Person and Phone number to contact in case of emergency:

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