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    8th Grade Bike Trip Release Form

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    grace.goblirsch1
    This health and release form is for a student participating in a 2023 bike trip. It collects the student's name, emergency contact information, health details like immunizations, medical conditions, medications, and doctors information. The parent agrees to emergency medical treatment if needed, acknowledges financial responsibility, and waives liability for the school or trip leaders for any injuries or damages from risks related to the bike trip activities.

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    © All Rights Reserved
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    8th Grade Bike Trip Release Form

    Uploaded by

    grace.goblirsch1
    7 views2 pages
    This health and release form is for a student participating in a 2023 bike trip. It collects the student's name, emergency contact information, health details like immunizations, medical conditions, medications, and doctors information. The parent agrees to emergency medical treatment if needed, acknowledges financial responsibility, and waives liability for the school or trip leaders for any injuries or damages from risks related to the bike trip activities.

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    This health and release form is for a student participating in a 2023 bike trip. It collects the student's name, emergency contact information, health details like immunizations, medical conditions, medications, and doctors information. The parent agrees to emergency medical treatment if needed, acknowledges financial responsibility, and waives liability for the school or trip leaders for any injuries or damages from risks related to the bike trip activities.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    7 views2 pages

    8th Grade Bike Trip Release Form

    Uploaded by

    grace.goblirsch1
    This health and release form is for a student participating in a 2023 bike trip. It collects the student's name, emergency contact information, health details like immunizations, medical conditions, medications, and doctors information. The parent agrees to emergency medical treatment if needed, acknowledges financial responsibility, and waives liability for the school or trip leaders for any injuries or damages from risks related to the bike trip activities.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    2023 Bike Trip Health and Release Form

    Student Name:

    Parent/Guardian:

    Home Address:

    Cell Phone: Alternate Phone:

    Doctor’s Name: Doctor’s Phone:

    Insurance Company: Policy Number:

    In an emergency, if unable to reach parent/guardian, contact:

    Name: Phone:

    1. All participants are required to have an up-to-date tetanus immunization. Does this student meet this
    requirement? YES NO

    2. Has this student recently been exposed to a contagious disease?


    YES NO
    If yes, please explain:

    3. Is this student diabetic? YES NO

    4. Does this student have any allergic reactions? YES NO

    If so, what is he/she allergic to?

    Please describe the allergic reaction:

    Please describe the specific treatment for the allergic reaction:

    5. Is the student taking any medication? YES NO


    If yes, please explain:

    By signing below:
    I give permission for non-prescription medication (e.g., ibuprofen/aspirin) to be given to my child by the
    parent in charge. In case of an emergency, I give my permission for the parent in charge to take whatever
    emergency measures (e.g., first aid, disaster evacuation) are deemed necessary for the care and protection of
    my child while under their supervision.

    1
    I acknowledge that in the event of a medical emergency, my child will be transported to the nearest hospital
    by ambulance if the local emergency resource (i.e. police or rescue squad) deems it necessary, for care and
    treatment. (Any directions to the contrary should be specified at the bottom of this form and signed). I will
    be responsible for the cost of transportation. It is understood that in some medical situations, local
    emergency resources may need to be contacted before the parent/guardian, child's physician, and/or other
    adult acting on the child's behalf.

    I give my permission for my child to participate in the Bike Trip, which is not sponsored by Highland
    Catholic School. I understand that the risks associated with this Bike Trip could result in injury and/or
    death to my child. I assume these risks and, knowing them, give my child permission to participate. I
    understand that the individuals overseeing the Bike Trip are not liable for any injuries or damages due to
    transportation, biking, camping, on-site activities, or related risks, and/or the actions or omissions of such
    individuals or any other entities being released. I also understand that the General Insurance Program for
    Highland Catholic School/Archdiocese of Mpls/St. Paul will not cover this non-school sponsored activity. I
    agree to hold harmless and indemnify Highland Catholic School/Archdiocese of St. Paul/Mpls and the
    individuals overseeing the Bike Trip from any claim, judgment, or expenses related to my child’s
    participation in this activity.

    Signed: Date:

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