Travel Permission Form

Note: Please complete Mr. Bellamy’s online participation agreement and medical information form at tcchs.org/pa as a prerequisite to travel.

TCBE Liability Release and Permission

For participation in off-campus activities and field trips sponsored by the Thomas County School District

"*" indicates required fields

I, the undersigned, for my child to participate in off-campus activities and field trips sponsored by the Thomas County School District, do hereby state and agree as follows:
1. Release and Permission*
In consideration of permission being granted to my child to participate in field trips and activities being sponsored by the Thomas County School District, I am entering into this release agreement which extends to the Thomas County School District, its agents, employees, volunteers, representatives, successors or assigns, both individually and in any capacity, (from now on referred to as releasees).
2. Authorization to Provide Medical Care*
Any chaperone appointed by the Thomas County School District or its designee has my permission to authorize emergency medical care for my child. My religious beliefs do not preclude any medications or normal emergency procedures.
My health insurance policy number is
My health insurance company is
3. Appointment as Attorney-in-fact*
I further appoint any chaperone appointed by the Thomas County School District as my attorney-in-fact to make any decisions they believe to be in my child’s best interest regarding obtaining emergency medical care. I further agree to accept liability for any expenses incurred by my attorney-in-fact while they act under the provisions of this instrument.
4. Responsibility for Medical Costs*
I understand that I will be responsible for the costs of any medical treatment provided to my child, and the chaperone(s) are authorized to sign any necessary documentation as my attorney-in-fact at any medical facility providing medical services for my child.
5. Release for Liability and Expenses*
I hereby grant Thomas County School District and its agents full authority to take whatever actions they may consider to be warranted under the circumstances regarding my child’s health and safety, and I fully release them from any liability for such decisions or actions as may be taken in connection herewith. I further agree to be liable for any expenses incurred by my attorney-in-fact while he or she is acting under the provisions of this instrument. I understand that I am responsible for my child’s medical insurance coverage.
Consent*
Signed by*
Enter the Parent/Guardian’s first and last name to sign this form electronically.
MM slash DD slash YYYY
Parent/Guardian Email*
Enter a parent/guardian’s email address that verifies their identity and provides delivery of confirmation.
Witness Name*
Witness Email*
Enter an adult witness’ email address that verifies the person signing this consent is the parent/guardian of the child. Do not enter a minor or student’s email address.
MM slash DD slash YYYY

Note: Please complete Mr. Bellamy’s online participation agreement and medical information form at tcchs.org/pa as a prerequisite to travel.