field trip permission

ARIZONA UPGRADE ACADEMY STUDENT TRAVEL FIELD TRIP PERMISSION FORM

I hereby permit ____________________________________________to participate in

(student)

___________________________________________________________ on ________________________

(describe trip/activity) (date(s))

Destination: _________________________

Date(s) of trip activity: _________________

Teacher: ____________________________

He/she will be transported by:

School bus _______ Fee required __________________

Private car _______ Other needs __________________

Walking _______

Transportation is the responsibility of parent _______

Other _______________________

(specify)

1. I understand that the Field Trip/Activity may take place away from school property; may involve

transportation by school bus, private vehicle, common carrier, or other mode of transportation; and may

involve activities beyond the scope of traditional school functions conducted on Arizona Upgrade Academy property.

2. I acknowledge that my student's participation in these activities potentially involves risks and obligations

that are impossible to predict, but may include the risk of loss or damage to personal property and the risk

of sickness, personal injury, or death.

3. I understand that Arizona Upgrade Academy does not purchase, or have, any medical, dental, or hospitalization

insurance to cover injuries to, or loss of life of, pupils or to indemnify parents and guardians for expenses in

connection therewith, and that such insurance, if desired, must be purchased by me.

Date: ________________ Signed: _______________________________________

(Parent or Guardian)

PLEASE RETURN THIS SLIP PROMPTLY

If you have special needs due to a disability, and wish to request accommodations in order to participate in this

activity, please notify the Arizona Upgrade Academy at least 2 days in advance of this event so that

appropriate arrangements for reasonable accommodations may be made.