Between Chesapeake Campus and Teel Campus 2016-2017

Between Chesapeake Campus and Teel Campus 2016-2017 At various times during the school year, students may have opportunities to participate in school-sponsored activities at the Teel Campus. These events, which usually occur during the school day, may be related to particular curricular areas, community service, or a grade level event. Notification of such events will be communicated to parents in advance. Bus transportation for these events will be provided by Severn School. Students should be in uniform for these events unless given specific instructions otherwise. All school rules are in effect during events at the Teel Campus. By signing this form, the parent or guardian gives permission for his/her child to participate and ride the bus between the Chesapeake Campus and the Teel Campus for all Teel Campus events during the school year. Permission forms for all other grade level field trips will be sent home accordingly throughout the year. Authorization to Treat a Minor: In the event that I cannot be reached in an emergency, I hereby permit Severn School and its representatives to call 911 and/or to contact a medical facility or physician selected by the School to provide proper treatment to the student named below and that I will be responsible for all expenses arising in association with such treatment. Prescription or Over the Counter Medication: I certify that I have on file in the School office a current profile listing any necessary medications that my child must take. Acknowledgement of Notification Regarding Risk: I hereby acknowledge that I will be notified if the activities involved in this trip are considered to be of “high risk” to the participants. Indemnity and Waiver of Claim: I, the undersigned, the Parent/Legal Guardian of the student named below, hereby acknowledge that as a condition of the student participating in the activity, agree to indemnify and hold harmless the School, its employees and volunteers, its governing board, the individual members thereof, and all other district officers, agents and employees from any liability, lawsuit, cost, expense or claim of any type whatsoever (including legal fees) for any harm, injury or death arising out of the above mentioned activity. I hereby give permission for my son/daughter to ride the bus between the Chesapeake Campus and the Teel Campus, and to participate in school events at the Teel Campus, during the school year. Student’s name: _____________________________________________________ _______________

Date: _______________________

(please print)

Parent/Guardian name: ________________________________________________________________________________________________ (please print)

Parent/Guardian signature: ___________________________________________________________________________________________

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