Trip Permission Slip

Trip permission slip.

Please state the name of the parent, referred to as PARENT, is the parent and lawful guardian of Please state the name of the child, a minor, and agrees:

Please state the name of the entity organizing trip is organizing a trip for the purpose of:

Please state purpose of the trip

on Please state the starting date of the trip through Please state the ending date of the trip.

Please state the name of the child has the permission of PARENT to participate in this trip and all activities thereof. Please state name of chaperone, Please state name of second chaperone and the other employees and adult agents of Please state the name of the entity organizing trip are herewith given the following authority on the dates stated above:

To consent to any medical treatment that may be required by Please state the name of the child in the place and with the same authority as Please state the name of the parent.

Further, in consideration of the services performed by Please state the name of the entity organizing trip and the employees, servants and agents of Please state the name of the entity organizing trip, Please state name of chaperone, Please state name of second chaperone and the other employees and agents of Please state the name of the entity organizing trip are herewith released from liability for all actions taken in good faith during the trip.

Dated: ______________________________________

_______________________________________________________________

Please state the name of the parent

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