Please complete the following survey for your child's release of liability. 

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* 1. I/We hereby grant permission for __________________________________________________________

To participate in an educational field trip to Tallahassee, Florida taking place from (Sunday), January 26th, 2020 thru Wednesday, January 29th, 2020 and to make incidental stops in route, when determined to be necessary or desirable, stay at a hotel, participate in Youth Advisory Committee activities, and return to Miami-Dade County.  In consideration of the benefits and opportunities afforded my child by his/her participation in the field trip, I/We agree as follows:


I/we have advised The Children’s Trust’s representative of any medical issues, including medication needed for my child and also authorize The Children’s Trust’s representative to obtain medical treatment for my child in the event of injury or illness and agree to pay all expense incurred for treatment.

I/we understand that my child is being transported in a commercial carrier chartered by The Children’s Trust, and if an injury occurs,  I/we, ____________________________________, the undersigned parent(s) or legal guardian(s), do hereby indemnify, release, and hold harmless The Children’s Trust (the “Trust”), and its officers, employees, agents and instrumentalities from any and all lawsuits, liability, losses or damages, including attorneys’ fees and costs of defense, which the Trust or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of relating to or resulting from our minor child’s or ward’s participation in this activity or trip sponsored by The Children’s Trust’s Youth Advisory Committee, including transportation arranged by the Trust to and from the Youth Advisory Committee activities.  

I/we have carefully reviewed this General Release and Waiver of Rights and have sought necessary advice before signing this form, which waives mine and my child’s or ward’s legal rights. 





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* 2. Date

Date

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* 3. Signature of Parent or Guardian

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* 4. Date

Date

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* 5. Signature of Parent or Guardian 

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