Student’s Name: _____________________________________(the Child) in grade _______
to participate in the Field Trip to: Camp Kandalore. on: Wednesday, January 12th (Date)
departing: 8:30 am returning: 4:30 pm, Wednesday, January 14th , at the approximate cost of $150.00,
the undersigned hereby releases Holy Trinity School, its respective directors, officers and employees
of and from any and all claims whatsoever arising or which may arise by reason of the Child’s
participation in the Field Trip including any claims due to personal injuries or illness excepting any such
claim resulting from and/or arising out of the gross negligence of Holy Trinity School, its respective directors,
officers or employees.
Should the Child suffer injury or illness while on the Field Trip, the undersigned hereby authorizes any representative of Holy Trinity School and, in particular, any teacher accompanying the Child to authorize such medical attention for the Child as may be deemed appropriate by said representative of Holy Trinity School in the circumstances. The undersigned agrees to bear the costs of all medical care and procedures required by the Child. The undersigned also agrees to maintain appropriate medical insurance coverage for the Child while on the Field Trip.
The undersigned hereby releases Holy Trinity School, its respective directors, officers and employees from any claim arising out of any medical treatment the Child may require.
The undersigned acknowledges that should the Child fail to keep and obey all rules and regulations prescribed by Holy Trinity School, its respective directors, officers and employees, while participating in the Field Trip, Holy Trinity School may, in its sole and absolute discretion, terminate the Child’s participation in the Field Trip without refund for the cost of the Field Trip. In the case of a day trip, it is unlikely that the Child would be returned to school. Were this to occur, the Child would return in the company of a member of the faculty. In the case of an overnight trip, the undersigned will be contacted in advance by the Headmaster to make the necessary arrangements to ensure that the Child is properly supervised on the return trip home. Any additional costs incurred by reason of the termination of the Child’s participation in the Field Trip and/or as a result of the Child being sent home will be the responsibility of the undersigned.
PLEASE CHECK ONE BOX, DATE AND SIGN BELOW
I have carefully read this Waiver and Permission
Agreement and understand the terms and conditions of it and agree to be bound thereby.
The Child has the undersigned’s permission to participate in the Field Trip and have the charge billed
to the Child's account.Signature of Parent or Guardian: ____________________________ Date: _______________
The Child will not participate in this Field Trip.
Signature of Parent or Guardian: ____________________________ Date: _______________
PLEASE ENSURE THAT YOUR CHILD RETURNS THIS FORM TO THE FRONT OFFICE
NO LATER THAN WEDNESDAY, JANUARY 5th