Parent Permission & Waiver Form

Scuola Italiana di Portland

Parent Permission & Waiver Form for Children’s Classes and Summer Camps

I/We, the parents/guardians of the student named below, understand that La Scuola Italiana di Portland will take students and summer campers on walking trips to parks and playgrounds in the area surrounding the school during hours of operation. These excursions are not preplanned into the school calendar and will occur periodically throughout the school year and during weekly summer camps as weather permits.

PERMISSION

We understand that walking excursions to local parks and playgrounds are a part of La Scuola Italiana di Portland’s children’s programs and we are in accord with the purposes of and procedures governing these activities. We hereby grant permission for our son/daughter to participate. We understand that adequate and appropriate supervision will be provided. In the event of an injury requiring medical attention, I hereby grant permission to the supervising teacher(s) or staff (including volunteers) to attend to my son/daughter. If the injury warrants further medical attention, I expect every effort will be made to contact me to receive my specific authorization before action is taken. If efforts to contact me are unsuccessful, I grant permission for necessary medical treatment to be given. In addition, I hereby give my permission to the supervising teacher(s) or staff (including volunteers) to take my child to the physician, dentist, or to the hospital if an accident or serious illness occurs on a trip and I cannot be located.

WAIVER

We recognize, however, that unanticipated situations and problems can arise on any trip, school -sponsored or otherwise, in which situations or problems are not reasonably within the control of the supervising teacher(s) or staff (including volunteers). We further agree to release and hold harmless La Scuola Italiana di Portland Board of School Directors, its agents, officers, employees, and volunteers, from any and all liability, claims, suits, demands, judgments, costs, interest and expense, (including attorneys’ fees and costs) arising from such activities, including any accident or injury to the student and the costs of medical services, or any cause beyond the control of SIdP, including, but not limited to, natural disasters, civil disturbances, acts of terrorism, and wars.

Student Name

First NameLast Name

Home Phone Number

Area CodePhone Number

Work Phone Number

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

Signature Parent 1

Date

MonthDayYear

Signature Parent 2

Date

MonthDayYear

Please check below IF your child has sensitivities to:

If other please list:

Please check below IF your child has:

If Other please explain:

If the student requires medication, I understand that I am obligated to ensure that the medication to be provided and a written letter of authorization are on file with the school. (If ordered by the student’s physician, an EpiPen must be provided for all field trips.)