Cherokee County School District

1 Cherokee County School District 221 West Main Street Canton, Georgia 30114 Phone 770-479-1871 ~ Fax 770-479-1236 Education Today For A Better Tomorrow FIELD TRIP PARENT CONSENT AND RELEASE FORM FIELD TRIP INFORMATION: Location/Event: (Jekyll Island Tournament of Champions) Transportation: (Parent Transportation) Day/Date: (March 9-11 2018) Cost: ($100) Payment Timeline(s): (Already Paid) Sponsor/Contact: (Matthew T. Rice) CONSENT AND RELEASE: I hereby consent on behalf of the individual named above to participate in a School -sponsored trip. In giving my consent I understand: o That participation in this School -sponsored trip is voluntary and not required by the Cherokee County School District and/or (my) (my child s) School .

2 This field trip is not required for the completion of any class, degree or course of study. The field trip is being offered as an augmentation of (my) (my student s) School -based education only. Should (I) or (my student) choose not to participate in the field trip such choice WILL NOT be held against (me) or (my student). o That participation in the field trip, especially trips including international travel, involves risks not found at (my) (my child s) School . The additional risk includes without limitation the risk of travel to/from and during the field trip; foreign political, legal, medical, social and economic conditions; and different standards for health and safety. o That the Cherokee County School District cannot eliminate all the risks involved with travel or guarantee the safety of (myself) (my child) while traveling.

3 With regard to international travel I have read and understand all information posted on the State Department website ( ), the Centers for Disease Control health advisory information relating to travel aboard ( ), and information on the World Health Organization website ( ). o That transportation may or may not be provided by the Cherokee County School District . In the event transportation is not provided by the Cherokee County School District , transportation will be the student(s) and parent(s)/guardians(s) responsibility. o That (I) (my child) will adhere to the Cherokee County School District current Disciplinary Code along with any trip specific conduct requirements while participating in this School -sponsored event.

4 The Cherokee County School District reserves the right to require the immediate termination of (my) (my student s) participation in a field trip in the event of a serious disciplinary infraction. By execution hereof I agree to pay/reimburse for the additional cost of transportation including my travel to pick up my child, if necessary, in the event field trip termination is required. o That I release and waive and further agree to indemnify and hold harmless and reimburse the Cherokee County School District , the Board of Education, its successors and assigns, its members, agents, employees, and representatives thereof, as well as the trip supervisor, from and against any claim which I, any other person, firm, corporation, or entity may have or claim to have, known or unknown, directly or indirectly, from any losses, damages or injuries out of, during, or in connection with the student s participation in the activity, any trip associated with the activity, or the rendering of emergency medical procedures or treatments, if any.

5 O That any field trip scheduled for my child may be canceled by the Cherokee County Board of Education due to a variety of reasons. These reasons may include but are not limited to: inclement weather, state or national emergencies, or exorbitant fuel costs. I understand that only the monies refunded to the School District would be refunded to me. I agree that in the event of a cancellation, the School District is not responsible for monies not refunded. o If any emergency medical procedures or treatments are required by the student during the trip, I hereby consent on behalf of (myself) (my child) to the trip s supervisor taking, arranging for, or consenting to emergency procedures or treatments in his/her discretion based upon the advice of medical professionals.

6 Please Print Below ** Student Name:_____ Male ___ Female ___ Parent(s)/Guardian(s) Name: Telephone: (WK) (HM) (Cell) Please Sign Below ** _____ _____ Signature of Parent/Guardian (or Student if +18 Years of Age) Date DR. FRANK R. PETRUZIELO SUPERINTENDENT OF SCHOOLS