This requires a contribution from you of $____________ to have the coverage extended to cover your daughter/ward for 365 days. (This contribution must be paid at the start of each school year.) Hired Transportation carries insurance for the vehicle and its passengers.
Please sign in the space provided on the attached form to indicate your understanding of the foregoing and to indicate your consent to _____________ ___________ NAME FORM attendance and participation subject to the conditions outlined above.
Yours sincerely, _______________________ Principal
______________________________ Dept. Head/Teacher Supervising
CONSENT FORM RE ________________________________________ (Activity)
_______________ (Date of Activity)
I consent to _________________________________________ of ________________ NAME FORM ATTENDING AND PARTICIPATING IN THE ACTIVITY SPECIFIED IN THE RELEVANT LETTER, AND I GIVE MY CONSENT TO HER PARTICIPATION SUBJECT TO THE CONDITIONS OUTLINED HEREIN AND I AGREE NOT TO MAKE ANY CLAIM ON THE SCHOOL SAVE AND EXCEPT IN CIRCUMSTANCES WHERE THE SCHOOL’S EMPLOYEE (AGENT OR REPRESENTATIVE) HAS BEEN NEGLIGENT.
________________________________ SIGNATURE
_______________________________ NAME PARENT/GUARDIAN
_________________________ DATE
______________________________ TELEPHONE NUMBER
63
