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Emergency Medical Treatment Consent 2026 FBLA STATE LEADERSHIP CONFERENCE
This google form will be completed in lieu of the paper version attached here: Emergency Medical Treatment Consent Document required by Boulder Valley School District for Extended Field Trips.  This form must be completed by March 12, 2026. 
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I acknowledge that I have been provided access to the  original document "Emergency Medical Treatment Consent Document" and I have opted to use this google form as an electronic version of the document.  Type your name for acknowledgment and permission to use your typed name in this electronic google form as an electronic signature. *
Please type in the response for:
 I/We, the undersigned Parent(s)/Guardian(s) Printed Names:
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Please type in the response for:
Student FIRST Name:
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Please type in the response for:
Student MIDDLE Name:
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Please type in the response for:
Student LAST Name:
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My student has the following medical condition(s)  which  may require emergency care(If not applicable please respond with NA):

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My student requires the following medications(If not applicable please respond with NA): *
For the FBLA State Leadership Conference Extended Field Trip I give my consent for emergency medical and/or surgical treatment in a licensed hospital by a licensed physician, should his or her condition require it in my absence. I understand that in such a case, reasonable attempts would first be made to contact me, time and conditions permitting.

During the dates (Departure - Return Dates) of:
Apr 1, 2026 to Apr 4, 2026

NOTE: School district personnel cannot administer medication without a written and signed request from the parent/guardian and a signed order from a physician stating the student's name, the name of the medication, the dosage, the method of administration, the time and the inclusive dates for which the medication is to be: given during a specific field trip.


As long as the medical or surgical treatment considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific prohibitions regarding treatment unless stated here (if none, so state):


I exempt the school district, its employees and authorized volunteers from all claims arising from the administration of (or failure to administer) medication and the administration of (or failure to administer) emergency medical treatment unless caused by actions for which the school district would otherwise be liable under Colorado law.


To be used for trips overnight, in-state or out-of-state and/or country. Parent(s)/Guardian(s) must complete the form and return to sponsor/building 2 weeks prior to the trip.


Please Type your name below the serve as your legal electronic signature.

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Emergency Medical Contact 1 FULL NAME: *
Emergency Medical Contact 1 MOBILE NUMBER: *
Emergency Medical Contact 2 FULL NAME: *
Emergency Medical Contact 2 MOBILE NUMBER: *
A copy of your responses will be emailed to .
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