Field Trip SFMOMA

WOODSIDE PRIORY SCHOOL

PARENTAL PERMISSION FORM

Trip Location:  SFMOMA 151 Third Street, San Francisco, CA 94103

Trip Date: Tuesday 10/25/2011                   Faculty Sponsor: Teri Scott

Educational Objective:  see contemporary art

Time of Departure from WPS: 10:15am

Return to WPS by:   3:00pm           Means of Transportation:   Van

Student Cost: Lunch $10-15

Charge to bookstore Account: $ 11 (bring student id)

The permission form needs to be returned by: 10/24/2011

Student’s Name _______________________________

Parent/Guardian’s Name ___________________________________

Home Phone ________________ Work Phone____________________

Other Phone                                    

Person (other than parent) to notify in case of emergency:

Name______________________      Phone ___________________________

I, the parent (guardian) of the above named child, hereby give my permission for his/her participation in the activity named above.   I agree to direct him/her to cooperate with the directions and instructions of the Priory School personnel responsible for the activity.

I agree, in the event my child is injured as a result of his/her participation in the above activity, including transportation to and from the activity, whether or not caused by the negligence (active or passive) of the Woodside Priory School or any of its agents or employees, to hold harmless and release the Woodside Priory School and any of its agents, from all liability and waive any claims against them.  I agree that recourse for the payment of any resulting hospital, medical or related costs and expenses will first be held against any accident, hospital or medical insurance, or any available benefit plan of the student involved.

I am not aware of any medical condition of my child that would render it inappropriate for him/her to participate in any such activity.

I hereby give permission to the physician selected by the Woodside Priory personnel then present to render medical treatment deemed necessary and appropriate by the physician.

Parent/Guardian Signature _____________________________                   Date_________