Medical Release printable pdf download

STUDENT’S RESPONSIBILITY AGREEMENT &

PARENTAL PERMISSION FORM

TRIP DESTINATION________________________________

DEPARTURE DATE___________________RETURN DATE_________________

STUDENT AGREEMENT

While participating in this ski trip, I accept full responsibility for maintaining good conduct and will follow the direction of

the chaperon/trip leader and trip captain, the rules of the resort and any state laws. I understand that curfews may be imposed

and that no alcoholic beverages and/or illegal drugs or narcotics are permitted. If I am found in possession of or under the

influence of alcohol or drugs, I understand that fines or arrest may result with my parents being notified and arrangements

made for any immediate transportation home. My behavior will not cause problems and I hope to enjoy this ski trip.

(If these rules place restrictions on your behavior, please do not go on the trip.)

(Print Name)________________________________________Age____________

__________________________________________________________________

Student’s Signature

Date

PARENT PERMISSION

I give permission for my child/children to attend the above described ski trip knowing that he/she and I accept responsibility

for his/her action at all times. I understand and agree that the chaperons/trip leader, trip captain, Ski World, and the ski

resorts do not assume any responsibility or liability from any injury my child may sustain. I also assume liability for any

damages by my child to the bus used for trip transportation.

I am aware that the legal age for consuming alcoholic beverages is 21. My child is a minor and is not legally entitled to

consume alcoholic beverages. I have therefore discussed with my child this matter and it has been agreed that absolutely no

alcohol or chemical substances will be consumed.

As parent or guardian of my minor child, I agree to be responsible for any and all damages, costs and fees carelessly,

recklessly or intentionally caused by my child. In case of medical emergency, I hereby authorize a hospital or qualified

physician to provide treatment which is deemed necessary for the well being of my child.

I have read this responsibility statement and have discussed it with my child. I am knowingly executing this agreement and I

do permit my child to attend this ski trip.

___________________________________________________________________

Parent’s Signature

Date

HOME #____________________ CELL____________________ EMERGENCY_______________________

MEDICAL INSURANCE_______________________________________________

ID/POLICY NUMBER_________________________________________________

Special Conditions (allergies, medication)_______________________________or use back of form

2013 Laskin Road – Virginia Beach, VA (757) 428-7551

12233 Jefferson Ave. - Newport News, VA (757) 249-0460

While on the trip this document will be kept in the records or in the possession of the Chaperon/Trip Leader or Trip Captain unless requested by Medical,

Police or Hotel Authorities.

Additional forms are available for pick up at Ski World offices; by requested E-mail at or downloaded from the internet at

Medical Release

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