Details about the new release you need to read are at sample off-campus FIELD TRIP/EXCURSION RELEASE OF LIABILITY and ASSUMPTION OF RISK FORM
in am leaving this webpage about the previous form for future reference.
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 De Anza College 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 along with you.
Go to:
http://purchasing.fhda.edu/risk-management/c-forms.html
if under 18 click on Student Field trip/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 legal name as it is on De Anza records________________, as the parent or
legal guardian, I authorize my child to attend and participate in the following “excursions/fieldtrip” (dates/location):
Dates of activity(ies), multiple dates are allowed, please be specific as to dates and purpose:
Monterey kayaking and possible hike at Point Lobos, 8 a.m. Sunday, May 15 or May 22, 2022
OR
Grand Teton National Park kayaking, August 14 – 30, 2022
OR
Yosemite National Park field trip, Feb. 3-5 to 30, 2023
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:
Legal Name of Student . . . the name used on college records, not a nickname you prefer . . . is easy enough, print clearly
Age: you must put your actual age or it will not be accepted by Risk Management!!
You can not write: “21 +” “over 18” or “old enough.”
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, 8 a.m. Sunday, May 15 or May 22, 2022
OR
Grand Teton National Park kayaking August 14 – 30, 2022
OR
Yosemite National Park field trip, Feb. 3-5 to 30, 2023
OR
(describe the event).
at the bottom don’t forget the
Signature of Adult Student and Date
and Phone number and email address of student
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?)
