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Field Trip Release Form

We request that our child be allowed to go on the field trip to with (hereafter the "Organization") presently scheduled to depart on and to return on

We understand that all rules of conduct and standards of behavior, as deemed by the Organization will apply to this trip and we have discussed these with our child. We further understand that we must assume all responsibility and liability for our child while traveling to, from, and during this trip. With this knowledge, we freely assume this responsibility and liability.

We also understand that it may not be financially feasible for the Organization to provide transportation for all those who are going on this field trip. Therefore, we understand that some participants may be traveling by bus or by privately owned vehicles which may or may not be covered by insurance. With this knowledge, we hereby consent to our child traveling to, from, and during this trip in either of these manners.

We further understand that the Organization is not responsible for any damages or accidents that may result from our child's actions or the actions of others. To the greatest extent possible, we release the Organization and the Diocese of Springfield in Illinois, and all those acting on their behalf, from all liability for damages to or caused by our child as a result of this trip and we agree to indemnify them for any such damages.

Emergency Contact/Medical Information

Father/Guardian: Daytime Phone:
Mother/Guardian: Daytime Phone:
Address Home Phone:
Other Contact Person Phone:
Medical Insurance Company
Company Address Policy Number:
Medical Conditions/Allergies Blood Type :

We hereby also give our consent for our child to receive emergency medical care during this trip.
We hereby also give our consent for photographs of our child to be taken and released.

Signature of Parent/Guardian Date:
Signature of Parent/Guardian Date:
Key Phrase:
Enter Key Phrase: