Kaohsiung American School Permission Sheet / Medical Form / Liability Waiver TO BE COMPLETE BY PARENT OR GUARDIAN
Name of Student: ______________________________________ Parent or Guardian Name: _______________________________ Phone: ___________________ Emergency Contact Person: (to call if parent cannot be reached) Name: _______________________________________________ Phone: ___________________ Circle relationship: Relative, Friend, Other
Medical Concerns that we should be aware of: __________________________________ ________________________________________________________________________ Medications or Allergies: __________________________________________________ ________________________________________________________________________ * Medications must be turned in to Mr. Choquette before departing KAS. All medication should be properly labeled with the student’s name, the doctor’s name, the name of the medication and the dosage.
The aims of this field trip is to reinforce what students have been learning in Science class and lead them to develop real world connections. All school rules and regulations will apply, students must remain with the chaperones. The safety of your student and their personal belongings is a top priority for Kaohsiung American School and the chaperones. The school and the chaperones are not responsible for lost, damaged or stolen personal belongings. DOES THE STUDENT HAVE PARENTAL PERMISSION TO ATTEND THIS FIELD TRIP?
YES
__________________________________________________ Signature of Parent/Guardian
___________________ Date
__________________________________________________ * Signature of the Student
___________________ Date
NO
* In signing this paper the STUDENT agrees to obey all school rules and instructions given by the chaperones.