Travel Release Behavior Contract

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T R A V E L R E L E A S E & B E H A V I O R C O N T R A C T
_________________________ has my permission to go to all Humble FFA Activities during the
2013-2014 School Year with Humble ISD and Humble FFA. Myself and child will read and understand all
guidelines and rules that will apply to this trip. We understand that the sponsor and chaperone(s) have the
right to search any items that are brought on the trip. Theses searches can occur anytime the sponsor or
chaperone see fit in order to protect the entire group. Students that participate in any trip will at all times be
under the rules and guidelines set by Humble ISD and its use of the ZERO TOLERANCE POLICY as stated in
the Student Handbook. I understand that myself and child can be held responsible for any damage that may
occur due to negligent behavior. I understand that the sponsor(s) in charge can set rules and guidelines as
needed to protect the entire group and that if any rules or guidelines are not followed any condition of the
following will occur:
1. The parents will be notified of any problem as seen fit by the sponsor(s).
2. The student will be sent home by the safest means possible, as soon as possible, at the total expense of the
parent.
3. The student will face disciplinary action as stated in the student handbook.
4. School officials will be notified of the students misconduct
Humble
5. The student will be removed from the
FFA Program either on a temporary or permanent basis. This
Humble
will include the loss of any current officer status and the right to participate in any event through
FFA.
We understand that the Humble Independent School District, Humble FFA/Agriculture Department, the
sponsor(s), and chaperone(s) cannot be held liable for accidents and that myself and child will be held
accountable for actions taken during this trip. This form must be signed by all involved, or the student will not
be allowed to attend trips with the Humble FFA.
____________________________________
____________________________________
Parent/Guardian Signature
Student Signature
_______________________
_______________________
_______________________
Home Phone
Work Phone
Other (please Identify)
Address:_______________________________________________
Family Physician’s Name and Phone: _______________________________________________
Allergies: _____________________________________________________________________
Medical Insurance Information:
Insurance Name:_______________________________
Policy Holder: ____________________________ Relationship to FFA member: ________________
Policy Name and/or Identification Number:_____________________________________________
Insurance Company’s Phone Number: ___________________________
FFA member’s Date of Birth: _______________________ SS # (opt.):_____________________
-In the event that emergency treatment or surgery is needed, a minor cannot be operated on, without the
consent of a parent of guardian. Parents should consider and act at their discretion on the following:
I give permission for _______________________________ to receive emergency treatment by a
qualified physician in any licensed hospital if the need should arise.
___________________________________
Parent/Guardian Signature
*** THIS FORM MUST BE SIGNED AND RETURNED TO THE ADVISORS PRIOR TO
ATTENDING ANY EXTRA- CURRICULAR ACTIVITY***

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