lausd field trip permission slip form

Student Off-Campus Activity Permission and Liability Release

Instructions for Use

• Complete all sections of this form in blue or black ink, ensuring all contact and medical information is accurate and current.
• Attach any necessary supplemental medical authorization forms if the student requires medication administration during the activity.
• Return the signed original document to the supervising teacher or school administrator no later than [Date] to ensure student participation.

Parties & Definitions

This Permission Slip (the "Agreement") is entered into by [Parent/Guardian Name] ("Parent/Guardian") on behalf of [Student Name] ("Student") and [School Name] ("School") regarding the following activity:

• Activity Name: [Activity Name/Description]
• Destination: [Destination Address/Location]
• Date(s) of Activity: [Start Date] to [End Date]
• Mode of Transportation: [Transportation Method, e.g., School Bus/Charter Bus]

Operative Clauses

1. Consent to Participate: Parent/Guardian hereby grants permission for the Student to participate in the off-campus activity described above. Parent/Guardian acknowledges that the Student is expected to follow all School rules and instructions provided by staff and chaperones.
2. Assumption of Risk: Parent/Guardian acknowledges that off-campus activities involve inherent risks, including but not limited to travel, physical exertion, and exposure to environmental conditions. Parent/Guardian voluntarily assumes all such risks associated with the Student’s participation.
3. Medical Authorization: In the event of an emergency, Parent/Guardian authorizes the School or its representatives to secure medical treatment for the Student. Parent/Guardian agrees to be financially responsible for all medical expenses incurred.
   • Student has no known medical conditions.
   • Student has the following medical conditions/allergies: [List Conditions]
4. Emergency Contact Information:
   • Primary Contact Name: [Name] | Phone: [Phone Number]
   • Secondary Contact Name: [Name] | Phone: [Phone Number]
5. Release of Liability: To the fullest extent permitted by law, Parent/Guardian hereby releases, waives, and discharges the School, its employees, agents, and the governing Board of Education from any and all claims, demands, or causes of action arising out of the Student’s participation in the activity, except in cases of gross negligence or willful misconduct.
6. Code of Conduct: The Student agrees to abide by the School’s Code of Conduct. Failure to comply may result in the Student being sent home at the Parent/Guardian’s expense.

Signature & Acknowledgment

By signing below, I certify that I have read this document, understand its terms, and voluntarily consent to its conditions.

Signature: __________ Printed Name: __________ Title: [Parent or Legal Guardian] Date: __________

Legal Disclaimer: This document is a general framework and does not constitute formal legal advice. Laws regarding liability waivers and parental consent vary by state and district; consult with qualified legal counsel to ensure compliance with specific jurisdictional requirements.