School Activity Form

2006/2007

I give consent for my child _______________________ to take part in any off campus school activity related to his/her participation in Band, requiring transportation by school bus or board approved vehicle.  I understand, should an accident occur while in a private vehicle, my insurance company would cover this.  In the even I do not have family auto insurance; I agree to be responsible for medical bills incurred and hold the School Board of Gilchrist County harmless.

Parent phone                                         Signature of Parent

Emergency Contact                                 Date

Medical Authorization

In case of accident or serious illness I ask that the school contact me.  If I cannot be contacted, I authorize the School Board of Gilchrist County, its agents and/or employees to administer first aid and consent to any first aid or medical care by any physician, hospital or attendant which is deemed necessary.  I agree to abide and be bound by such decisions and consent as if made by me and assume full financial responsibility for al expenses of such care. 

Health Insurance Company                                                                            

Policy Number                                                                                               

This authorization is valid during the time by child is attending school within this district regarding school related activities

Signature of Parent

Sworn and Subscribed before me this ____ day of _______, _______ .

Personally known or produced _______________________ for identification.

Notary Public, State of Florida