field trip release

To go on an off-campus club field trip/event, a student (or a parent/guardian for a student under 18 years old) must sign a release along with the trip agreement.

The instructor/club advisor for the event must have the release from the student (parent/guardian) before the event.

All documents must be signed in person, (there are no online signups for Outdoor Club events).

If you are under 18 years old, your parent/guardian must sign documents in person.

Go to:
http://purchasing.fhda.edu/risk-management/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

MINOR: (under 18 years old)

Name of Student … the name used on college records, not a nickname you prefer . . . 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 Mary Donahue

Campus: write in De Anza

at the bottom of the page where it says:

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):

Grand Teton National Park kayaking and possible camping, August 11 – 21, 2019

OR

Monterey kayaking and possible hike at Point Lobos, 8 a.m. 8 a.m. Sunday, May 12, 2019 or 8 a.m. Sunday, May 19, 2019.

OR

Yosemite National Park field trip, Jan. 31 to Feb. 2, 2020

OR

(describe the event).

Don’t forget the print name and sign name at the bottom

do not fill in the blanks for

Signature of Instructor/Staff Member ________ Date ____

DO have a parent print the info: In the event of an emergency, I can be reached at: (phone numbers)

18 or over:

Name of Student . . . the name used on college records, not a nickname you prefer . . . is easy enough, print clearly

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

Instructor/District Representative: print Mary Donahue

Campus: print De Anza

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

Grand Teton National Park kayaking and possible camping, August 11 – 21, 2019

OR

Monterey kayaking and possible hike at Point Lobos, 8 a.m. 8 a.m. Sunday, May 12, 2019 or 8 a.m. Sunday, May 19, 2019.

OR

Yosemite National Park field trip, Jan. 31 to Feb. 2, 2020

OR

(describe the event).

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?)

stained glass window showing mountains and lakes