Loma Linda Academy
10656 Anderson Street
Loma Linda, CA 92354
(909) 796-0161 xt 1001
Field Trip Consent
Place:____________________________
Date:_____________________________
Departure Time:____________________
Return:___________________________
Mode of Transportation:______________
Cost:_____________________________
(retain top portion for your information)
------------------------(return bottom portion to your child’s teacher)-----------------------
PLACE:___________________________
DATE:____________________________
NAME OF CHILD:_________________________________
I understand the arrangements and give permission for my child to attend. I also agree to indemnify and hold harmless the Loma Linda Academy, Southeastern California Conference and Association of Seventh-day Adventist, and sponsors from liability arising from any accident or injury occurring during this trip. This specifically includes injury arising from negligence on the part of those mentioned above. This recognizes a shared responsibility between school, student, and home. This does not include gross negligence on the part of those mentioned above.
This does not waive coverage within the policy limits of student accident insurance which covers school sponsored activities.
*___________________________________ ___________
SIGNATURE OF PARENT/GUARDIAN DATE
In the event of sudden illness or accident requiring attention, my child has permission to obtain emergency medical treatment. On the first day of the trip I,
_____________________________________(Name of Parent) can be reached at ___________________________________(Phone number)
Please indicate any medical problems, allergies, medications________________
*____________________________________ ___________
SIGNATURE OF PARENT/GUARDIAN DATE
_____Yes, I can drive for this field trip and have seatbelts for ______# of students.
_____I cannot drive but would like to go if there is enough transportation.
_____Yes, the teacher has a copy of my driver’s license, insurance verification, and driver information form
on file for the CURRENT school year. (for drivers)
_____No, I have not completed the driver information form (including a copy of my driver’s license and
insurance verification). I will come into the elementary office at least 48 hours before the field trip
and complete the necessary forms
_____I can go on the bus as a chaperone.
BECAUSE THE RESPONSIBILITY OF BEING A CHAPERONE DEMANDS THE FULL ATTENTION OF THE PARENT, SIBLINGS WILL NOT BE ALLOWED TO ACCOMPANY US ON ANY FIELD TRIPS OR RECREATIONAL TRIPS THROUGHOUT THE SCHOOL YEAR. PLEASE FEEL FREE TO CONTACT THE ELEMENTARY OFFICE IF YOU HAVE ANY QUESTIONS.