release formTo 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/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 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:
ocean kayak day trip October 20 or 27, 2013, 9 a.m. all day, Monterey, California
or camping trip, Yosemite National Park, all weekend Feb. 7-9, 2014
or Grand Teton National Park kayaking trip, August 25 to September 4 +/-, 2014
or waterfront lifeguard in-service training, June 7, 2014, approx 11 a.m., Aquatic Park, San Francisco
or surfing lesson, 8 a.m. to noon, Cowell's Beach, Santa Cruz May XX, 201X
or Paintball, Los Gatos Pursuit field, all day, 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:
ocean kayak day trip October 20 or 27, 2013, 9 a.m. all day, Monterey, California
or camping trip, Yosemite National Park, all weekend Feb. 7-9, 2014
or Grand Teton National Park kayaking trip, August 25 to September 4 +/-, 2014
or waterfront lifeguard in-service training, June 7, 2014, approx 11 a.m., Aquatic Park, San Francisco
or surfing lesson, 8 a.m. to noon, Cowell's Beach, Santa Cruz May XX, 201X
or Paintball, Los Gatos Pursuit field, all day, 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.
|