Loading...

Editing previous response:

Please fix the highlighted areas below before submitting.

2023-24 Field Trip Waiver and Medical Authorization

FIELD TRIP WAIVER

My student has permission to depart via walking/bus transport from school grounds under staff supervision in order to visit local community assets through out the 2023-24 academic year. Such locations may include but are not limited to:

• The Elkhart Public Library

• The Lerner Theatre

• Beacon Aquatic Center

• Midwest Museum of American Arts

Please select one
Answer Required

MEDICAL WAIVER

In the event of illness injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.

Medication needed on trip: All medication (prescriptions or over the counter) must have a physician/parent authorization form accompanying medication. All medication must be kept and distributed by staff, excepting those indicated by the medication authorization form that must be kept on the student's person for emergency use. Authorizations must be submitted with medication to school personnel before leaving. Medication must be supplied in the original container. Medication brought without proper authorization will be confiscated and not dispensed to student.

I understand that I hold Premier Arts Academy, its officers, agents and employees, harmless from any and all liability or claims, which may arise out of or in connection with my child's participation in this activity.*
Answer Required
Confirmation Email