2020-21 Grandview Theatre Medical/Field Trip Forms, Transportation Awareness Form & Acknowledgement of Risk
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Email *
Student Last Name *
Student First Name *
Parent 1 Name AND email address *
Parent 2 Name AND email address
Medical Form: Travel will only occur if permitted by the district in 2021-22 due to COVID-19. I/we give permission for this student to travel with the Theatre on dates during the 2020-2021 school year. I/we do hereby authorize officials of the Cherry Creek School District to contact directly the people named below and do authorize the named physician or associates to render such treatment as deemed necessary in an emergency, for the health of said child. In the event that parents, guardians, or other people named, or the physician on this form cannot be reached, the school officials are hereby authorized to take whatever action is deemed necessary in their judgement for the health of the aforesaid child. I/we understand that the district does not provide health or medical insurance on students. I/we further understand that I/we are responsible for payment of all health, medical and emergency care treatment provided for my child (ren) while participating on this trip. I/we grant permission for my son/daughter to use the following transportation: school bus, commercial bus lines, commercial airlines, adult driven automobiles, including sponsors and or parent drivers. I/we understand, and my son/daughter agrees that my son/daughter is to adhere to all Cherry Creek School District disciplinary policies and procedures while on this trip. I/we grant permission to the sponsors to do what is recommended and necessary to control or modify any behavior by my son/daughter who they (sponsors) perceive as being a violation of these policies, procedures, or that becomes a problem in any way, I/we will accept a collect call from the sponsors and with them consider the manner in which the problem will be promptly solved. *
Home Phone Number *
Parent 1 Cell Number *
Parent 2 Cell Number
Alternate Emergency Number *
Mother Work Number
Father Work Number
Doctor's Phone Number *
Hospital Name *
Name of Insurance Company *
Address of Insurance Company *
Insurance Subscriber's Name *
Student's Insurance Policy ID Number *
Nearest Relative *
Nearest Relative Phone Number *
Date of Birth Insured *
I/we hereby represent to the Cherry Creek School District that the student is in good physical health and the trip does not pose a health hazard to the student. *
I/we hereby grant permission and give consent for the above named student to 1) be treated by any qualified nurse, physician or surgeon as may be deemed necessary by CCSD, its agents, servants or employees during the trip: 2) be administered medication and or emergency first aid care as may be necessary or appropriate; 3) receive treatment in hospitals, medical offices, clinics, or elsewhere in the event of accident or illness. I/we understand and agree that neither CCSD nor its agents, servants, or employees are responsible for obtaining or for the result of any medical or emergency treatment rendered or supplied to the student. I/we will hold the CCSD, its agents, employees, and servants harmless and indemnify them from any claim, cause of action or demand arising out of any form of (or lack of) medical or emergency treatment rendered to the student. *
Please list all allergies (including FOOD), medications, or other medical problems which your son/daughter has. *
CHERRY CREEK SCHOOL DISTRICT Grandview High School PERMISSION TO PARTICIPATE/RELEASE, ACKNOWLEDGEMENT OF RISK, ASSUMPTION OF PERSONAL RESPONSIBILITY AND INDEMNITY FORM I/We, the Parents/Guardians of (herein Child), hereby give our consent and permission for our child to participate in any sponsored Performing Arts Activity which shall be scheduled during the 2021-22 school year. I/we understand that during my child’s participation in the Activity; he/she may be exposed to risk or possible injury. I/we understand that I/we assume the risk for any injuries or damages resulting from my child’s participation in this activity. I/we have accepted responsibility to verify with my physician that my child has no physical or psychological problems that would prohibit his/her participation in the activity, and agree to advise my child to comply with the instructions and directions of the School District, agents, volunteers and/or employees as participants in this activity. I/we, in return for my child’s opportunity to participate in the Activity do hereby exempt and release Cherry Creek School District, its directors, officers, employees, volunteers and agents from any and all liability, claims, demands or actions whatsoever arising out of any damage, loss or injury that my child or I/we might sustain while my child is participating in the activity, whether or not such damage, loss or injury results from the acts or omissions of Cherry Creek School District, its directors, officers, employees, volunteers or agents. I/we understand that if I/we do not sign this Release, then my child will not be permitted to participate in the Activity. I/we hereby represent that I am/we are 18 years of age or older, and that I am/we are the parent(s) guardian(s) of the Participant. I/we further acknowledge that no representations or promises by Cherry Creek School District representatives have been made to induce me to sign this Release. I/we further agree to indemnify, hold harmless and defend Cherry Creek School District, from any claim, cause of action or demand, of any sort or nature, which may at any time be filed or asserted by the Participants participation in the Activity which indemnification shall include any costs and attorneys’ fees that may be incurred as a result of any claims, causes of action or demands. This release is valid and effective whether the damage, loss or injury is a result of any act or omission on the part of Cherry Creek School District or its agents, volunteers, or employees. I understand that I voluntarily give up my right to sue the above-mentioned parties. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF ALL LIABILITY AND A WAIVER OF ANY RIGHT THAT I MAY HAVE ON BEHALF OF MYSELF AND/OR MY CHILD/WARD TO BRING LEGAL ACTION OR ASSERT CLAIM FOR INJURY OR LOSS OF ANY KIND AGAINST CHERRY CREEK SCHOOL DISTRICT. IF ANY ATTEMPT FOR CLAIM IS MADE, I UNDERSTAND I WILL BE RESPONSIBLE FOR ALL DEFENSE COSTS INCURRED.I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THE ABOVE, BEEN GIVEN THE OPPORTUNITY TO ASK QUESTIONS, CONSIDER ITS EFFECTS, UNDERSTAND THIS ENTIRE DOCUMENT AND AGREE TO BE BOUND BY ITS TERMS. *
Media: I give permission for my student's photo/video to be used in communications or on the performing arts website in accordance with district media policy.
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The student fully agrees and consents to the foregoing *
Date of Student Agreement *
Parents/Guardians fully agree to the foregoing *
Date of Parent Agreement *
Address of Student *
Address of Parent/Guardian if different
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