WOODSIDE PRIORY SCHOOL
PARENTAL PERMISSION FORM
Trip Location: : deYoung Museum Golden Gate Park
50 Hagawara Garden Drive San Francisco, CA 94118
Trip Date: Tuesday 3/27/12 Faculty Sponsor: Teri Scott
Educational Objective: view Gaultier show at deYoung Museum
Time of Departure from WPS: 10:00am
Return to WPS by: 3:00pm Means of Transportation: Van
Student Cost: lunch $10
Charge to bookstore Account:
$16 admission ticket/part of student fees
The permission form needs to be returned by: 3/24/2011
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_________
