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.
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