release form

To go on an off campus De Anza Outdoor Club (or any other club) event, a student (or a parent/guardian for a student under 18 years old) must sign a release.

You can get a copy of the release form and fill it out in advance of signing up for a trip to make the signing up go faster.

(Sorry, you can’t turn it forms or sign up for events on-line.)

How to get the form:

Go to:
http://business.fhda.edu/risk/c-forms.html

if under 18 click on Student Fieldtrip/Excursion – Minor Authorization form and print the form

for 18 or over click on Voluntary Assumption of Risk and print the form

How to fill out the form so you won’t have to do it over when you give it to the club:

MINOR:(if you are under 18 years old)

(If you are not under 18, see below at 18 or over.)

Name of Student … is easy enough, please print clearly.

Age: (age of the student) You must put your age or it will not be accepted by Risk Management!!

Instructor/District Representative: write in Outdoor Club, varies (or for Paintball or another Karate Club event write in Karate Club)

Campus: write in De Anza

I, the undersigned certify that I am the parent or legal guardian of _____print the student’s name____, as the parent or
legal guardian, I authorize my child to attend and participate in the following “excursions/fieldtrip” (dates/location): describe the event … examples:

surfing lesson, 8 a.m. to noon, Cowell’s Beach, Santa Cruz May 14, 2017

or Grand Teton National Park kayaking trip, August 14 to September 2 +/-, 2017

or kayak day trip/possible hike Sunday, October 22, 2017, all day, Monterey, California

or camping trip, Yosemite National Park, all weekend Feb. 2 to 4, 2018

or Lake Tahoe day trip Sept. 10, 2016, 9 a.m. to 7 p.m., Meeks Bay, California

or Paintball, Los Gatos Pursuit field, all day, 8 a.m. Oct. XX, 201X

At the bottom, don’t forget the print name of Parent/legal guardian and sign name of Parent/legal guardian, and Date

do not fill in the blanks for

Signature of Instructor/Staff Member ________ Date ____

DO print the info: In the event of an emergency, I (Parent/legal guardian) can be reached at: (phone numbers)

18 or over:

Name of Student… is easy enough, print clearly

Age: you must put your age or it will not be accepted by Risk Management!!

Instructor/District Representative: print Outdoor Club, varies (or for Paintball or another Karate Club event write in Karate Club)

Campus: print De Anza

Dates of activity(ies), multiple dates are allowed, please be specific as to dates and purpose:

describe the event … examples:

surfing lesson, 8 a.m. to noon, Cowell’s Beach, Santa Cruz May 14, 2017

or Grand Teton National Park kayaking trip, August 14 to September 2 +/-, 2017

or kayak day trip/possible hike Sunday, October 22, 2017, all day, Monterey, California

or camping trip, Yosemite National Park, all weekend Feb. 2 to 4, 2018

or Lake Tahoe day trip Sept. 10, 2016, 9 a.m. to 7 p.m., Meeks Bay, California

or Paintball, Los Gatos Pursuit field, all day, 8 a.m. Oct. XX, 201X

at the bottom don’t forget the

Signature of Adult Student and Date

don’t fill in the blanks at

Signature of Instructor/Staff Member ____ Date ______

but do fill out the

In the event of an emergency, please contact: example: name, phone number, relationship to you (mom, friend, roommate?)

Bring the completed form with you when you come to sign up for the event. Or if the event does not have sign ups/payment, get it to the advisor BEFORE the event.

Outdoor Club Coming Attractions has how to find us to sign up for events.