Field Trip Permission Form & Waiver 2018-19
Field Trip Permission Form and Waiver
Your child has received charter school approval to participate in Gorman Learning Charter Network (GLCN) field trips for the 2018-19 school year. Under the California Educational Code and Board Policy, teachers and support staff may take students on field trips to enrich and complement their educational experience. Such trips are always under the supervision of at least one teacher and/or school administrator and/or staff and all precautions are taken to ensure each student's welfare. Though most field trips require parent/guardian attendance and transportation, this form MUST be submitted for attendance to ANY field trip.

PLEASE NOTE: GLCN field trips are for our students, their minor-aged siblings, and their custodial parents/guardians only. GLCN pays for all enrolled students attending field trips, while families pay for all other admission and parking fees.

Child's Name *
Your answer
Gorman Student *
Grade Level *
Child's Age *
Your answer
Family's PLT (Personalized Learning Teacher) *
Your answer
PLT's Phone *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone *
Your answer
Waiver of Claim:
I understand that AB 766 provides that all persons attending field trips or excursions shall be deemed to have waived all claims against the Charter School for injury, illness or death occurring during or by reason of the field trips or excursions. I therefore acknowledge that as a condition of my son/daughter/ward participating in said activities, I hold harmless and waive any and all claims against the Charter School and their insurer (including their officers, employees, agents), and including but not limited to, claims arising out of any negligence of any officers or employees of the Charter School, for any injury, accident, illness, or death, or any loss or damage to personal property occurring during or by reason of the participation in said activities.
Parent/Guardian please check next to each line below indicating you have read and agree: *
Required
AUTHORIZATION TO TREAT MINOR
In the event that I, or any parent/legal guardian, cannot be reached in an emergency, I hereby give permission to the school staff to secure proper treatment for my child. I do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services. The undersigned parent/legal guardian fully understands that they are responsible to pay all costs incurred as a result of treatment.
Parent/Legal Guardian Name: *
Your answer
Parent/guardian E-mail Address *
Your answer
Parent/guardian Cell Phone *
Your answer
Parent/guardian Home Phone *
Your answer
Parent/guardian Work Phone
Your answer
Other Emergency Contact Person *
Your answer
Relationship to Child *
Your answer
Emergency Contact Phone *
Your answer
Child's Physician's Name *
Your answer
Physician's/Group's Phone *
Your answer
Health Insurance Name *
Your answer
Policy Number *
Your answer
Student's Medical Needs / Allergies / Conditions / Medications *
Your answer
Additional Information
Your answer
ACKNOWLEDGEMENT: Please check the box below to agree to the following: *
Required
Chaperon Acknowledgement
Required of Parents or Guardians AND non-GLC student attendees 18 years and older. To be completed by all non-student attendees age 18 or older (including parent filling out this form). Check the box below to agree to the following:
*
Required
Names of All Adults/Guardians/Parents (chaperons) attending: *
Your answer
Family Financial Obligation Acknowledgement
Check the box below to agree to the following:
*
Required
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