Trip
Location: ______________________________________________
Depart: Date: _____ Time:___
| Return: Date:
_____ Time: ___
Sponsor(s):
______________________________________________
Cost: ______________________
My
child, (name) _____________________________has my permission to go on the
abovementioned trip. I understand the arrangements and give permission for my
child to attend. I also agree to indemnify and hold harmless the sponsoring church and staff, the
sponsoring Pathfinder Club and staff, and the Potomac Conference of Seventh-day
Adventist and sponsors from liability arising from any accident or injury
occurring during this trip. This specifically includes injury arising from
negligence on the part of those mentioned above. This recognizes a shared
responsibility among church, student and home. This does not include gross negligence
on the part of those mentioned above. This does not waive coverage within the
policy limits of church accident insurance, which covers church sponsored
activities.
(Date) (Signature of
Parent/Guardian)
______________________________________ ________________
In the event of
sudden illness or accident requiring attention, my child has permission to
obtain emergency medical services. During the trip I can be reached at
following numbers:
Home: ______________ Work:______________ Other:__________________
Please indicate any medical problems, allergies, or medications:
_________________________________________________ ___________________ (Signature of
Parent/Guardian) (Date) Vienna
Stars Pathfinder Director :