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2026-27 Field Trip Waiver and Medical Authorization

Please fill out this form if you have not filled it out for the 2026-27 School Year.

If you have filled it out in past school years, please fill it out again to ensure our staff has the most accurate and up to date information.

Student First Name*

Answer required for "Student First Name"

Student Last Name*

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Parent/Guardian First Name*

Answer required for "Parent/Guardian First Name"

Parent/Guardian Last Name*

Answer required for "Parent/Guardian Last Name"

Parent/Guardian Cell Phone Number*

Answer required for "Parent/Guardian Cell Phone Number"

Parent/Guardian Email*

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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 2026-27 academic year.

Please select one

Answer required for "Please select one"

I GIVE MY CONSENT

I DO NOT CONSENT

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.

Family Medical Insurance Carrier

Answer required for "Family Medical Insurance Carrier"

Policy #

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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.

List any medications required:

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If your student has any special medical problems, please list and write a description of that problem. Include what school personnel need to know if a problem arises:

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By electronically signing this form, 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.

Signature*

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Confirmation Email

Confirmation Email *

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