General Trip Permission and Medical Waiver (2017/18)
Occasionally, our older children and youth go on offsite field trips or camp outs. Please fill out this form if you have a child in 5th grade or above, or you are able to drive on a field trip.
Child/Youth First and Last Name
Your answer
By filling out this form, I grant permission for my child to participate in Religious Education (R.E.) field trips and to be transported in the personal car of an adult driver while participating in this activity. I agree to hold harmless and blameless Bellingham Unitarian Fellowship (BUF), its employees, and all adult chaperones from any and all liability from damages, loss, or injuries, either to person or property, which my child may sustain while engaged in this field trip, including, but not limited to transportation. Should any injury occur, I grant permission to the supervising adult to authorize necessary medical services, including injections, anesthesia, surgery, and medication, if I cannot be contacted at the telephone numbers shown above. I agree to be responsible for any expenses not covered by my insurance that may be incurred as a result of an accident or medical emergency involving the above-named child. *
Parent/Gardian Name *
Your answer
Insurance Information
Health Insurance Provider
Your answer
Group ID
Your answer
Policy #
Your answer
Subscriber Name
Your answer
Employer
Your answer
Doctor Name and Phone Number
Your answer
Emergency Contact Name and Phone Number
Your answer
Special Health Concerns or Allergy Information
Your answer
Field Trip Driver Information
________________________________________________________________________________________________________________
Driver Name
Your answer
Vehicle Make and Model
Your answer
Insurance Carrier
Your answer
Policy #
Your answer
Number of children that can safely travel in your vehicle:
Safe Church Policy
BUF and the RE program welcome all children and youth and their families. We encourage all members of the congregation to volunteer with the children and youth as they are willing and able. Because we value the special circle of trust that we have created here, we require all adult volunteers who work with children and youth to consent for criminal background check and sign a code of ethics. We accept the responsibility to educate ourselves and our children about sexual misconduct, abuse, molestation, harassment and exploitation. We pledge to conduct ourselves in a manner that conveys mutual respect. If you have any questions about this, please contact Jennifer Smith, Director of Lifelong Learning.
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