8/9/2019 Convention Permission 2010

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PERMISSION SLIP

LIABILITY AND MEDICAL RELEASE FORM

I, the undersigned parent or legal guardian of _____________________________(student

name printed) do hereby grant permission for my student to attend the Key Club Convention fromMarch 26-28, 2010, in Boise, Idaho. I furthermore hereby release the _____________ School

District, its representative, agents and employees from liability for any injury to my child resulting

from any cause whatsoever while being transported to or from, or attending the named event,

excepting only such injury resulting from willful acts of representatives, agents, servants, and

employees.

1. I do voluntarily authorize _______________School District employees and/or others

chaperoning the event to administer routine first aid procedures and/or authorize emergency

medical treatment as may be deemed necessary by attending medical personnel.

2. I agree to indemnify and hold harmless the ___________________ School District and itsemployees for any and all claims, demands, actions, rights of action, and or judgment by or on

behalf of the named person arising from or on account of said procedures and/or treatment

rendered in good faith and according to accepted medical standards.

3. I authorize my student to be excused from school March 26, 2010, to attend, and be

transported to the convention.

4. I understand that students are not allowed to have cars, or transport students to or from the

convention. Neither _________________ School District, or ______________ High School, will

be providing transportation to and from the convention. Transportation is provided by

commercial charter bus furnished by Le Bus. _________________School District, nor_________________ High School, its employees or agents are not responsible in any way for any

accident or injury that might occur during the course of travel to and from any convention related

activity.

5. It is understood and agreed that convention attendees will use Le Bus to be transported to

some convention activities and meals that are held away from the main convention location.

The undersigned have read the trip guidelines as well as this form and understand them.

It is understood that if my student violates convention guidelines, he or she could be sent home at

the expense of the parent or legal guardian. It is expressly understood the affixing my signature

below constitutes agreement to all points of this document.

Date:________________________________________

______________________________

________________________________

Parent/Guardian Name Printed Parent Signature

8/9/2019 Convention Permission 2010

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Having read and understood completely the Key Club Convention trip guidelines, I do hereby

agree to follow the procedures and practices described. I fully understand that this is an activity

designed to educate Key Club members about the functions of the club. I will, to the best of myability, apply myself to accomplishing the purposes of the convention in order to more effectively

promote the activities of Key Club at _____________High School. I furthermore agree to

conduct myself at all times so as to uphold the finest qualities of a person representing

______________________ High School and the ______________________ School District.

___________________________________ _______________________________

Student Name Printed Student Signature