Pupil's Name:

Boiling Springs High School

Activity:

Starting Date:   Ending Date:

 I approve of the activity described and the above named pupil has my consent and permission to fully participate.  I understand that throughout this activity, he/she will be under the supervision, custody, and the control of the teachers, employees, and assigned chaperones for the school district.

Accordingly, I authorize such teachers, employees, or agents of the school and the district wherever they may be during the activity to exercise the same authority over him/her as is provided by law or regulation conducted in the classrooms or on school property during regular school hours.  If my student does not follow the direction of the teachers and chaperones on the trip, I understand that I will be asked to arrange transportation home prior to the end of the trip. Special medical needs or concerns are noted on the back of this form.

The undersigned is parent, guardian, or has legal custody of the pupil named and is authorized to grant this permission and consent. Form must be signed to be valid.

Signed this _______________day of____________________, 20__________

Print Name of Parent:

Signature of Parent:_____________________________________________________

Home Phone:Parent Work Phone:Cell Phone:

I agree to abide by school rules and follow the directions of the adults (teachers and chaperones) on this trip. 

Student's Signature:______________________________________________________

Form 2