English Permisson Form Link

Field Trip Permission Form

First name

Last name

Date of Birth

Student Cell Phone

Parent Cell Phone

Student Home Address

Parent/ Guardian Approval

Yes

Date

Parent/ Guardian Initials

I declare that the info I’ve provided is accurate & complete

I understand that students will be under the supervision of Fusion Charter faculty or staff during this voluntary activity. My student and I fully understand that my student must abide by all school rules and regulations during this event. Any violation of these rules and regulations may result in disciplinary consequences. I am aware that during any school-sponsored activity certain dangers may occur, including, but not limited to, hazards of accidents, hazards created by the forces of nature, and hazards of travel to the event. In the event of illness or injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care is considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital facility furnishing medical or dental services. As stated in the California Education Code (Section 35330), I understand and do hereby assume all of the above mentioned risks, will hold harmless Fusion Charter and Aspiranet, its officers, agents or employees from any and all liability or claims whatsoever which may arise out of or in connection with a trip or participation in any activities arranged for the student by Fusion Charter. The terms thereof shall serve as a release and assumption of risk for my heirs, executor and administrators and for all members of my family.

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