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://business.fhda.edu/risk/forms

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):

Monterey kayaking and possible hike at Point Lobos, 9 a.m. Sat. April 1 or Sat. April 8, 2017

OR

Grand Teton National park kayaking and possible camping, August 14 to September 2 2017

OR

Yosemite National Park field trip, Feb. 2 to 4, 2018

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:

Monterey kayaking and possible hike at Point Lobos, 9 a.m. Sat. April 1 or Sat. April 8, 2017

OR

Grand Teton National park kayaking and possible camping, August 14 to September 2 2017

OR

Yosemite National Park field trip, Feb. 2 to 4, 2018

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?)