Field Trip Consent-Release Form Overnight
Field Trip Consent-Release Form Overnight
HOPKINTON PUBLIC SCHOOLS
Field Trip (Overnight)
Consent Form, Release from Liability & Indemnity Agreement
I/We, the undersigned parent(s) or guardian(s) of , a minor, do hereby
CONSENT to his/her/their participation in the trip to (hereafter referred to as the Field Trip) planned for through , 20 ,
with transportation provided by and sponsored by the (ex. charter bus, school bus, walking, private auto)
Hopkinton Public Schools.
I/We forever RELEASE and discharge the Town of Hopkinton and its departments, officers, employees, and agents (hereinafter collectively referred to as “Hopkinton”), from any and all claims, damages, losses or expenses of whatever kind or nature which
I/We may have or acquire as the parent(s) or guardian(s) of said minor arising out of or resulting, directly or indirectly, from
said minor’s participation in the Field Trip. I/We also RELEASE and discharge Hopkinton from any and all claims, damages,
losses or expenses of whatever kind or nature which said minor may have or acquire arising out of or resulting from, directly or
indirectly, his/her/their participation in the Field Trip.
I/We furthermore agree to defend and INDEMNIFY against any claim, damage, loss or expense of whatever kind or nature that Hopkinton may have to pay that arises from said minor’s intentional, grossly negligent, or reckless acts or omissions while participating in the Field Trip.
I/We hereby authorize Hopkinton’s employee(s) or agent(s) who is supervising said minor, and/or the host family of said minor
(if applicable) to act on our behalf in authorizing and consenting to emergency medical care including surgery, if necessary,
dental care, and/or hospitalization for said minor if he/she becomes ill or is injured while participating in the Field Trip. This
Authorization and Consent may be presented to the appropriate medical/dental staff at such time as emergency medical care,
dental care or hospitalization is required. I/We hereby RELEASE and discharge Hopkinton from any and all claims of any
nature whatsoever, which may arise out of the decision to provide emergency medical care, dental care or hospitalization during
the Field Trip.
I/We also hereby authorize Hopkinton, acting through the Superintendent of Public Schools or his/her/their designee, to cancel,
reschedule or alter in any other manner the Field Trip whenever he/she/they determines in his/her/their sole discretion that such
cancellation, rescheduling or alteration is required in order to protect the safety and welfare of said minor.
I/We agree to release
Hopkinton from any claim for damages or loss that I/we may incur by reason of such cancellation, rescheduling or alteration.
I/We further authorize Hopkinton’s employee(s) or agent(s) who is supervising said minor while participating in the Field Trip
to require said minor to comply with any rules, standards of behavior or instructions such employee(s) or agent(s) may
I/We agree that such employee(s) or agent(s) shall have the right to enforce such rules, standards of behavior or instructions and shall have the further right to terminate said minor’s participation in the Field Trip at any time when such employee(s) or agent(s) considers the conduct of said minor incompatible with the interest, harmony, comfort or
welfare of the other participants in the Field Trip or with said minor’s own safety or welfare. Possession, sale, distribution or use of illegal drugs, alcohol or a weapon(s) will automatically constitute grounds for terminating said minor(s) participation.
If said minor’s participation is terminated, I/we consent to have said minor sent home in the most expeditious manner without refund at my/our expense.
I/We accept in good faith the determination of such employee(s) or agent(s) in all matters relating to the supervision of said minor while on the Field Trip.
👎My child requires special accommodations If medical, contact school nurse.
State accommodation on line above or contact the principal.
Signature of Parent or Guardian__________________________________
Signature of Parent or Guardian_________________________
This Form May Not Be Altered 10-03-02 Policy Name Revision 6/6/2019
- A - Foundations and Basic Commitments
- B - School Board Governance and Operations
- C - General School Administration
- D - Fiscal Management
- E - Support Services
- F - Facilities Development
- G - Personnel
- H - Negotiations
- I - Instructional Program
- J - Students
- K - School-Community Relations
- L - Education Agency Relations