CHRIST LUTHERAN MINISTRIES
FIELD TRIP PERMISSION FORM
The undersigned hereby requests and gives permission to take ___________________________
on
the following trip to __________________________________________________________
and with this signed agreement absolves the staff, Christ Lutheran Ministries, and any and all
members of its governing boards of any responsibility for the safety, welfare,
health and well-being of the child named above, beyond such matters as may be
called reasonable care for children in the custody of a staff member and
subject to the staff member’s clear instructions, and assumes personally and
exclusively all responsibility and liability for accident, injury, etc., which
may occur to the above-named child during the time of the specific activity as
set forth at the beginning of the paragraph.
The trip begins at ____________________ and the children should be back
at school by
_______________ on
_____________________________.
Staff Member ________________________________________
will accompany the group.
Transportation
is by
_________________________.
Cost of the trip is _________________.
Bring lunch ( ) do not bring
lunch ( ).
Parent/Guardian’s Signature ________________________________Date
________________
THIS FORM MUST BE SIGNED AND RETURNED. ONLY THOSE CHILDREN WHO RETURN THIS FORM PROPERLY SIGNED CAN BE GRANTED PERMISSION TO PARTICIPATE.
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I am able to drive and can provide transportation for ______ seat belted children.
___________________________________ __________________
Driver Telephone #